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THE EFFECT OF YASTI KSHEERA DHARA AND SARPI NASYA IN NIDRANASHA - A COMPARATIVE CLINICAL STUDY” BY G.DEEPAK, Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. Research ...

THE EFFECT OF YASTI KSHEERA DHARA AND SARPI NASYA IN NIDRANASHA - A COMPARATIVE CLINICAL STUDY” BY G.DEEPAK, Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. Research Center, Gadag.

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  • “THE EFFECT OF YASTI KSHEERA DHARA AND SARPI NASYA IN NIDRANASHA - A COMPARATIVE CLINICAL STUDY” BY G.DEEPAK Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. In partial fulfilment of the degree of AYURVEDA VACHASPATI IN PANCHAKARMA Under the guidance of DR. SURESH BABU. S M.D. (AYU), FRAV (GOI, Delhi) Professor P.G. Dept. of Panchakarma And co-guidance of DR. SANTOSH N. BELAVADI M.D. (Ayu) Asst. Professor P.G. Dept. of Panchakarma POST GRADUATE DEPARTMENT OF PANCHAKARMA, D.G M.AYURVEDIC MEDICAL COLLEGE AND RESEARCH CENTER, GADAG – 582103. 2007-2010“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  • DECLARATION BY THE CANDITATEI hereby declare that this dissertation / thesis entitled “The Effect of Yasti KsheeraDhara and Sarpi Nasya in Nidranasha - A Comparative Clinical Study” is a bonafideand genuine research work carried out by me under the guidance of Dr. Suresh Babu. SM.D. (Ayu), FRAV (GOI, Delhi) Professor and the co-guidance of Dr. Santosh N. BelavadiM.D(Ayu), Asst.Professor, Post Graduate Department of Panchakarma, ShriD.G.M.Ayurvedic Medical College, Gadag.Date: Signature of the CandidatePlace: Gadag (G.Deepak) “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  • CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “The Effect of Yasti KsheeraDhara and Sarpi Nasya in Nidranasha - A Comparative Clinical Study” is a bonafideresearch work done by G.Deepak in partial fulfillment of the requirement for the degreeof Ayurveda Vachaspathi. M.D. (Panchakarma).Date: Signature of the GuidePlace: Gadag Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI, Delhi) Professor P.G. Dept of Panchakarma Shri.D.G.M. Ayurvedic Medical College, Gadag. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  • CERTIFICATE BY THE CO-GUIDE This is to certify that the dissertation entitled “The Effect of YastiKsheera Dhara and Sarpi Nasya in Nidranasha - A Comparative Clinical Study” isa bonafide research work done by G.Deepak in partial fulfillment of the requirement forthe degree of Ayurveda Vachaspathi. M.D. (Panchakarma).Date: Signature of the Co-GuidePlace: Gadag Dr. Santosh N. Belavadi M.D. (Ayu). Ast. Professor P.G. Dept of Panchakarma D.G.M Ayurvedic Medical College, Gadag. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  • J.S.V.V. SAMSTHE’S SHRI D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG POST GRADUATE DEPARTMENT OF PANCHAKARMA ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “The Effect of Yasti Ksheera Dhara and Sarpi Nasya in Nidranasha - A Comparative Clinical Study” is a bonafide research work done by G.Deepak under the guidance of Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI, Delhi) Professor, and co-guidance of Dr. Santosh N. Belavadi M.D. (Ayu) , Asst. Professor, Post Graduate Department of Panchakarma, Shri. D.G.M.A.M.C, Gadag and contributed good values to the Ayurvedic research. Dr. Sivaramudu M.D. (Ayu), M.A (San), M.A (Psy) Dr. G. B. Patil Prof. and H.O.D. Principal, P.G. Dept of Panchakarma Shri. D.G.M. Ayurvedic Medical College,Shri. D.G.M. Ayurvedic Medical College, Gadag Gadag.Date: Date:Place: Gadag Place: Gadag “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  • COPYRIGHT Declaration by the Candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation / thesis in print orelectronic format for academic / research purpose.Date: Signature of the CandidatePlace: Gadag. G.Deepak © Rajiv Gandhi University of Health Sciences, Karnataka. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  • Acknowledgement ACKNOWLEDGEMENT At this happiest juncture of successful completion of this research work, Iprostrate to the lotus feet of “Lord Dhanvantri”, with whose showering of blessings thistask was ventured without any hindrances. I express my deep sense of gratitude to his great holiness Jagadguru ShriAbhinava Shivananda Mahaswamiji, for their divine blessings. Next I pay my obeisance to my Late Grand Father Dr.P.Kesava pillai Ex C.C.I.Mmember and N.Velayuda pillai, I pay respect to my Father Dr.K.Gopakumar M.D (Sid),my Mother V.Sreekala, for taking pain to bringing up me to this position. I thank mysister Dr.G.Divya BAMS who supported in my entire career and continuousencouragement. I grab the opportunity to express my deep sense of gratitude to my guideProfessor Dr.Suresh Babu.S M.D (Ayu), FARV (GOI, Delhi), whose sympathetic,compassionate and commendable nature gave me considerable boost, always providedme enough courage to cope up with each and every task during my P.G. studies. At such an auspicious moment, it is my pleasing privilege to express my respecttowards my co-guide, Dr.Santosh N. Belavadi M.D (Ayu) his inspiration, guidance andencouragement at every step of my work. I am extremely grateful and obliged to Professor Dr.P.Sivaramudu M.D (Ayu),HOD, Dept of Panchakarma for his affection, experience and intelligence guidance. I am sincerely thankful to Professor Dr.G.Purushothamacharyulu M.D (Ayu),who was former H.O.D. of the department, for his scholarly guidance. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  • Acknowledgement I sincerely convey my thanks to beloved principal Dr.G.B.Patil for his all timesupport and providing all necessary facilities for this research work. I express my sincere thanks to Dr. Rajashekar C.V M.D (Ayu), who was formerteacher in the department, for his valuable suggestions. I am deeply indebted and sincerely thankful to Dr.Jairaj Basarigidad M.D (Ayu),Dr. Yasmeen Phaniband M.D (Ayu), for their precious suggestion and co-operationthroughout the study. I am grateful to all the PG teachers Dr.K.S.R.Prasad, Dr.M.C.Patil, Dr.Mulugund,Dr.G.S.Hiremath, Dr.R.V.Shettar, Dr.Girish Danappa Goudar, Dr.Jagadeesh Mitti,Dr.Kuber Sankh, Dr.Shashikanth Nidugundi, Dr.B.M.Mulkipatil and Dr.M.D.Samudri,for their valuable inputs and suggestions. I extend my immense gratitude to Dr.V.M.Sajjan, Dr.Purad, Dr.SuvarnaNidugundi, Dr. Shakuntala and other teaching staffs who helped during my study. I express my sincere thanks to Sri.Nandakumar, for his help in statistical analysisof results. I take the privilege to thank Sri.Mundinamani, Librarian. I also extend mythanks to assistant librarians Mr.Shyavi and Mr.Keroor who provided me all thenecessary books and time for my literary work. I extend my thanks to Sri Kulakarni, SriNabi, Smt. Sunanda and Smt Renuka for their timely help in my clinical trail. I express my thanks to Dr.Ratnakumar and Dr.Udaykumar for their sincere words,which made me to join in this Institution. I feel extremely thankful to my seniorsDr.Ashok.M.G, Dr.Prasanna V.Joshi, Dr.Sanjeev Chaudary, Dr.Sathish, Dr.Subin,Dr.Febin, Dr.Madhushree, Dr.Prasanna Kumar, Dr.Siba Prasad, Dr.Payappa Gowdar, “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  • AcknowledgementDr.Devandrappa Budi, Dr.Nataraj, Dr.Udaya Ganesha, Dr.Adarsh, Dr.Shailej, Dr.MuktaHiremath and others for valuable suggestions. I pay sincere regards to my fellow colleagues Dr.Sabareesh, Dr.Rajesh,Dr.Jayasankar, Dr.Sanath kumar D.G, Dr.Ishwar Patil, Dr.Praveen Nayak, Dr.Bodke,Dr.Kanti, Dr.Shakunthala, Dr.Asha, Dr.C.C.Hiremath, Dr.Rotti, Dr.Bupesh, Dr.Gorpade,Dr.Deepa, Dr.Jadav, Dr.Mahantesh Swami Hiremath and Dr.Praveen Palyed for theirtruly help and co-operation. I thank my juniors Dr.Joshi Goerge, Dr.Anish, Dr.Vishwajith, Dr.Renukaraj,Dr.Sangamesh, Dr.Jayakar, Dr.Sathish, Dr.Raghavendrachar, Dr.Jagadeesh, Dr.Maneesh,Dr.Paresh, Dr.Shilpa, Dr.Bhaghyesh and Dr.Vijay Mahanthesh for their support. I pay sincere regards to my fellow colleagues in the other colleges,Dr.T.V.Dhanvanthari, Dr.Shivakumar and Dr.Girish for their support. Iam also very much thankful to Mr. Shakthi (Local Guardian) andDr.K.S.R.Prasad who made my stay comfort through out my P.G. carrier. I pay sincere regards to my UG friends Dr.Nepoleon, Dr.Kavas anand,Dr.S.E.Sivakumar, Dr.Seejith warrier, Dr.Vijith Nangelil, Dr.Surej, Dr.Sundar andDr.Sriram of SJSAC, Chennai, for their indirect support for my entire PG career. Lastly but not least I express my thanks to each and every person who have giventheir Support in accomplishing this task without any blemishes.Date :Place : Gadag Dr. G.Deepak “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  • AbbreviationsLIST OF ABBREVIATIONS USED: A.H – Ashtanga Hrudaya A.S – Ashtanga Samgraha B.P – Bhavaprakasha B.S – Bhela Samhita C.S – Charaka Samhita M.N – Madhava Nidana S.S – Sushruta Samhita V.S – Vangasena Y.R – Yogaratnakara “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  • Abstract ABSTRACT Nidranasha is one among the eighty Nanatmaja Vata Vikaras described byAcharya Charaka. Acharya Vagbhata indicated Brhmana Nasya for the treatment ofNidranasha. In the context of Murdhini taila, Shirodhara is also advised in the treatmentof Nidranasha. Hence, an attempt had been done to evaluate the effect of theseprocedures by undertaking the research work with the title “The Effect of Sarpi Nasyaand Yastiksheera Dhara in Nidranasha – A Comparative Clinical study”.Objectives of the study:(1) To evaluate the efficacy of Nasya karma in Nidranasha.(2) To evaluate the efficacy of Yastiksheera Dhara in Nidranasha.(3) To compare the efficacy of Yastiksheera Dhara versus Sarpi Nasya in NidranashaMaterials and Methods: A total of 30 patients were selected from O.P.D and I.P.D of D.G.M.A.M.C & Hafter fulfilling the inclusion and exclusion criteria randomly. They were divided in to twogroups Group A and Group B. 15 patients of Group A underwent Sarpi Nasya for sevendays. Group B patients underwent Yastiksheera Dhara for seven days. Assessment of results was done by considering the base line data of subjective andobjective parameters to pre and post medication and was compared for assessment of theresults. All the results were analyzed statistically for “P” value using Un-paired t-test.Subjective Parameters: Anganmarda, Shirogaurava, Jrumbha, Sleeplessness, Difficultyin Initiating Sleep, Sleep Quality, Performance of Daily Activities, Vitality AfterMorning Awakening, “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  • AbstractObjective parameters: Total Sleep time, Wakefulness during Sleep, Sleep HistoryQuestionResults:The overall results of the study were as follows;Group A: 02 (13.33%) shown Good response to the treatment. 10 (66.66%) were shownModerate response and 03 (20.00%) patients shown Poor response.Group B: 12 (80.00%) were shown Good response to the treatment and 03 (20.00%)patients shown Moderate response. From the statistical analyses, all parameters shows non-significant (as P>0.05).i.e., the mean affects of treatment same in all the parameters. All the parameters showshighly significant in both the Groups as P<0.05.Comparative efficacy: Overall the group B (Yastiksheera Dhara) is more effective thangroup A (Sarpi Nasya) in almost all the parameters. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study”
  • Contents Contents Contents Page number 1. Introduction 1-2 2. Objectives 3-7 3. Literary review 8 - 92 4. Materials and methods 93 - 106 5. Observations and results 108 - 164 6. Discussion 165 - 180 7. Conclusion 181 8. Summary 182 - 186 9. Bibliography 187 - 203 10. Annexure 204 - 213“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 46
  • List of Tables & Figures LIST OF TABLES Table no. and content PageNo.Table no.01 showing the Time of Administraion 16Table no. 02 showing the Time schedule for Nasya karma in Rogi 23Table no. 03 showing the Probable Drug Dosage for Nasyakarma 24Table no.04 showing the Synonyms of Anidra 46Table no.05 showing the Nidana of Nidranasha 47Table no.06 showing the Rupa 57Table no.07 showing the Ekamulika prayoga in Nidranasha 64Table no.08 showing the variability between NREM & REM 70Table no.09 showing the Hours of Sleep according to Age 74Table no.10 showing the Drugs used for Ghrita murchana 88Table no.11 showing the Properties of Yastimadhu 90Table no.12 Showing the Therapeutic Actions of Yastimadhu 91Table no.13 showing the ksheera properties 91Table no.14 Showing the Milk Composition Analysis 92Table no.15 showing the Sleep history Questioner 102Table no16 showing the distribution of patient’s age group 108Table no.17 showing the distribution of patients according to sex 109Table no.18 showing the distribution of patients by Occupation 110Table no19 showing distribution of patients by Economical status 111Table no.20. Showing distribution of patients by Marital Status 111Table no 21 showing distribution of patients by Pradhana Vedana 112Table no 22. Showing distribution of patients by Anubanda vedana 113Table no 23. Showing distribution of patients by Mode of Onset 114Table no 24. Showing distribution of patients by Kula vruttanta 115Table 25 Showing distribution of patients by Occupational History 116Table no 26. Showing distribution of patients by Vihara 116Table no 27. Showing distribution of patients by Vyasana 117Table no 28 Showing distribution of patients by Satva 118Table no 29 Showing distribution of patients by Vyayama Shakti 118Table no 30 Showing distribution of patients by Vaya 119Table no 31 Showing distribution of patients by Aharaja hetu 120Table no 32 Showing distribution of patients by Viharaja hetu 121Table no 33 Showing distribution of patients by Manasika Hetu 122Table no 34: Showing the History Questionaire before treatment 123Table no 35: Showing the History Questionaire after treatment 124Table no 36: Showing the Angamarda before treatment 125Table no 37 Showing the Angamarda after treatment 126Table no 38 Showing the Shirogaurava before treatment 126Table no 39 Showing the Shirogaurava after treatment 127Table no 40 Showing the Jrumbha before treatment 128Table no 41 Showing the Jrumbha after treatment 128Table no 42 Showing the Sleeplessness before treatment 129 “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 46
  • List of Tables & FiguresTable no 43 Showing Sleeplessness after treatment 130Table no 44 Showing the Difficulty in Initiating Sleep before 131treatmentTable no 45 Showing the distribution of patients by different grades 132of Difficulty in Initiating Sleep after treatmentTable no 46 Showing the Sleep Quality before treatment 133Table no 47 Showing the Sleep Quality after treatment 134Table no 48 Showing the Performance of daily activities before 135treatmentTable no 49 Showing the Performance of daily activities after 136treatmentTable no 50 Showing the Vitality after Morning Awakening before 137treatmentTable no 51 Showing the Vitality after Morning Awakening after 138treatmentTable no 52 Showing the Total Sleep Time before treatment 139Table no 53 Showing the Total Sleep Time after treatment 140Table no 54 Showing the Wakefulness During Sleep before 141treatmentTable no 55 Showing the Wakefulness During Sleep after treatment 142Table no 56 Showing the Overall Response to the treatment 143Table no 57 showing the Comparative Study of Group A and 144Group B after treatmentTable no 58 showing Individual study of group-A 145Table no 59 showing Individual study of group-B 145Table no 60 Showing Demographical Data 147Table no 61 Showing Demographical Data 148Table no 62 Showing Demographical Data 149Table no 63 Showing Demographical Data 150Table no 64 Showing Demographical Data 151Table no 65 Showing Demographical Data 152Table no 66 Showing Demographical Data 153Table no 67 Showing Demographical Data 154Table no 68 Showing Demographical Data 155Table no 69 Showing Demographical Data 156Table no 70 Showing Demographical Data 157Table no 71 Showing Demographical Data 158Table no 72 Showing Subjective Parameter of Group A 159Table no 73 Showing Subjective Parameter of Group B 160Table no 74 Showing Objective parameter Group – B 161Table no 75 Showing Objective parameter Group – B 162Table no 76 Showing Sleep Questioner of Group A 163Table no 77 Showing Sleep Questioner of Group B 164 “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 47
  • List of Tables & Figures LIST OF FIGURE Figure PageNoFigure no.01 Showing the States and Stages of Sleep 69Fig No 02 showing the distribution of patient’s age group 109Fig No 03: showing the distribution of patient’s sex group 110Figure 04 showing distribution of patients by occupation 110Figure 05 showing distribution of patients by Economical status 111Figure 06 showing distribution of patients by Marital Status 112Figure 07 showing distribution of patients by Pradhana Vedana 113Figure 08 showing distribution of patients by Anubanda vedana 114Figure 09 showing distribution of patients by Mode of Onset 114Figure 10 showing distribution of patients by Kula vruttanta 115Figure 11 showing distribution of patients by Occupational History 116Figure 12. Showing distribution of patients by Vihara 117Figure 13 showing distribution of patients by Vyasana 118Figure 14 showing distribution of patients by Satva 118Figure 15 showing distribution of patients by Vyayama Shakti 119Figure 16 showing distribution of patients by Vaya 120Figure 17 showing distribution of patients by Aharaja Hetu 121Figure 18 showing distribution of patients by Viharaja hetu 122Figure 19 showing distribution of patients by Manasika Hetu 123Figure 20 showing Sleep History Questionaire before treatment 124Figure 21 showing Sleep History Questionaire after treatment 125Figure 22 showing Angamarda before treatment 125Figure 23 showing Angamarda after treatment 126Figure 24 showing Shirogaurava before treatment 127Figure 25 showing Shirogaurava after treatment 127Figure 26 showing Jrumbha before treatment 128Figure 27 showing Jrumbha after treatment 129Figure 28 showing Sleeplessness before treatment 130Figure 29 showing Sleeplessness after treatment 131Figure 30 showing Difficulty in Initiating Sleep before treatment 132Figure 31 showing Difficulty in Initiating Sleep after treatment 133Figure 32 showing Sleep Quality before treatment 134Figure 33 showing Sleep Quality after treatment 135Figure 34 showing Performance of daily activities before treatment 136Figure 35 showing Performance of daily activities after treatment 137Figure 36 showing Vitality Morning Awakening before treatment 138Figure 37 showing Vitality Morning Awakening after treatment 139Figure 38 showing Total Sleep Time before treatment 140Figure 39 showing Total Sleep Time after treatment 141Figure 40 showing Wakefulness During Sleep before treatment 142Figure 41 showing Wakefulness During Sleep after treatment 143Figure 42 showing Overall Response to the treatment 144 “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 48
  • Introduction INTRODUCTION “A good laugh and long sleep are the best cures in the doctor’s book” Ayurveda the holistic science believes mainly on preventing from diseases andcuring the diseases. According to Ayurveda Life sustains on three basic pillars – ahara,nidra and brahmacharya. This dictum of charaka clearly illustrates the importance ofNidra. The necessity of sleep is demonstrated by experiments in which animals deprivedof sleep die within a few weeks. Humans deprived of sleep for 60 to 200 hours begins todemonstrate a breakdown in concentration, motor skills, self care, attention, judgmentand eventually communication, debilitated appearance, skin lesions, increased foodintake, decreased body temperature and death. Hallucination and illusions may appear. There is however, a wide variation in the requirements for sleep, which isdetermined by genetic factors, habits formed early in life and particular physical andemotional states. This shows that if a person is deprived of good sleep will suffer frommany health problems as stated above with good sleep many physiological changes occurin respiration, cardiac function, muscle tone, temperature, hormone secretion and bloodpressure. More over good sleep serves a restorative, homeostatic function and appears tobe crucial for normal thermoregulation and energy conservation which are disturbed inthe sleep disorders like Nidranasha (Insomnia). Our Ayurveda Acharyas have visualized this scenario century’s ago. Prescribed anatural and refreshing line of approach to this lack of sleep problem – Nidranasha.Acharya charaka has mentioned Nidranasha as one among the vataja Nanathmaja vyadhi.Nidra is induced due to kapha and thamobhava. The symptoms of Nidranasha areAngamarda, Shirogaurava, Jrumbha, Jadya, Glani, Bhrama. Acharya charaka has “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 1
  • Introductionexplained Sukha, Dukha, Sthoola, Krusha, Bala and even Marana depends on the nidra.Nidranasha is also one of the important lakshana in many diseases. Nidranasha can be co-related with Insomnia. Insomnia is the condition ofinadequate quantity or quality of sleep. It may be a symptom of a depressive illness,anxiety disorder or other psychiatric condition. Even though there is an effective line of management for Insomnia which is thenear equivalent term for Nidranasha, but ultimately it may cause addiction. That is why asearch for an alternative line of treatment is carried out. Lot of unique therapeuticmodalities has been mentioned in Ayurveda, one of such modalities is Nasya karmawhich is the component of Panchakarma. While searching for such alternative treatment Ifound Brhmana Nasya with Sarpi indicated in Nidranasha. Since nidranasha is aurdhwajathrugata vikara nasya appears to be perfect line of treatment. As per dictum“Naasa hi Shiraso Dwaram”1a,b. Vagbhata2 a indicated the brhmana nasya in Nidranasha,basing on this apthavachana Sarpi has been taken for the trial as it is a Brhmana Dravyaand is taken as Group - A. Another procedure which is said to be effective and refreshing one is Shirodhara,which is indicated in Nidranasha is also selected for another group of patients calledGroup – B. In this way a comparative study “The Effect of Sarpi Nasya and YastiksheeraDhara in Nidranasha – A Comparative Clinical Study” has been designed with thefollowing aims as (1) To evaluate the efficacy of Nasya karma in Nidranasha. (2) To evaluate the efficacy of Yastiksheera Dhara in Nidranasha. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 2
  • Introduction (3) To compare the efficacy of Yastiksheera Dhara versus Sarpi Nasya inNidranasha and conducted as per the Research protocols on 30 subjects (patients)2 b. Thefinal results are evaluated clinically and statistically and decreased in the relevantchapter. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 3
  • Objectives OBJECTIVES Ayurveda, the holistic science believes mainly in preventing diseases and curingthe diseases. Various unique therapeutic modalities have been mentioned in Ayurveda,one such modality is Panchakarma therapy. Acharya Charaka has mentioned Nidranashaas one among the Vataja Nanathmaja Vyadhi. Nidra is induced due to Kapha andThamobhava. The symptoms of Nidranasha are Angamarda, Shirogaurava, Jrumbha,Jadya, Glani, Bhrama. Acharya Charaka has explained Sukha, Dukha, Sthoola, Krusha,Bala, and even Marana depends on the Nidra. Nidranasha is the common and the most widely recognized sleep disorder.Nidranasha can be co-related with Insomnia. Insomnia is the condition of inadequatequantity (or) quality of sleep. It may be a symptom of a depressive illness, anxietydisorder (or) other Psychiatric condition. Sleep problems are common across all age groups, although the prevalence ofparticular kinds of problems may vary with factors, such as age, lifestyle, shift work,comorbid disease states, etc. 73% of the individuals surveyed complained of a nocturnalsleep problem and 9% had severe insomnia.The prevalence of severe insomnia rangedfrom 4% to 22%. Patients attending general practice clinics have a high prevalence ofinsomnia, and physicians must be on the lookout for these sleep disturbances so that theycan offer appropriate treatment. The importance of adequate knowledge of insomniacannot be overemphasized so that clinicians can efficiently manage this common healthproblem in primary care3. About one-third of adults reported at least one sleep complaint or problem (e.g.,difficulty falling asleep or staying asleep, or early morning awakening). The prevalence “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 3
  • Objectivesof sleep problems increases with age and is higher for women than for men. Whereasprevalence estimates of insomnia in childhood and adolescents do not appear to differbetween boys and girls, and gender differences are small or nonexistent between persons20–40 years old, investigations spanning the age range from 18–79 years indicate thatwomen, compared with men, are about 1.3 times more likely to report insomnia-likesleep problems4. Use of prescription medication in patients with sleep difficulty was reported by20% of men and 29% of women. Doctors have a lot of influence on patients use ofhypnotics and need to give proper information and advice to their patients whenhypnotics are prescribed. Adolescents and young adults (12-25 years) are at high risk forproblem sleepiness with particularly serious consequences3. About a third, adults experience some type of sleep disorder during their lifetimes.Over half of persons with Nidranasha do not seek medical advice at any time. But thesehypnotic or sedative drugs are not so effective and pose increased risk of psychologicalbehaviour. Keeping behind the limitations of drug therapy in other popular remedialsciences, research activities in Ayurveda for diseases like Nidranasha become intensive inthe recent years. Some studies have already been conducted in the management of Nidranasha withvarious Panchakarma Therapies are as follows,(1) Nirmal Dhamini:- A Role of Manas Bhavas in Anidra and its management withcertain indigenous drugs and shiro dhara, Department of Manasa Roga, 2004, Jamnagar.(2) Puja Muralidhar:- The Effect of Shiro Basti in the mangement of Nidranasha W.S.Rto primary Insomnia, Department of Kaya Chikitsa, 1999, Govt. Ayurvedic Medicalcollege, Mysore, RGUHS Bangalore, Karnataka. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 4
  • Objectives(3) Todkar Swati:- A study of the effect of Abhyanga Karma in Nidranasha, Departmentof Swastha Vritha, 2005, Pune.(4) Chaudhari (Ms) Rupali T:- Analytical study of Nidra in Shleshmala Prakriti, 2005,Department of Shareera kriya, M.A.M.S.S.B Ayurvedic Mahavidyalaya, Hadaspar, Pune,Pune University, Pune.(5) Nisha N.T:- Care of Nidra in Old- A natural approach through Abhyanga and Yoga,2003, Department of swasthavritha, Govt. Ayurvedic College, Kerala University,Thiruvananthapuram.Aims and Objectives of the Study:(1) To evaluate the efficacy of Nasya karma in Nidranasha: The Nasya is one among the Panchakarma which is especially indicated forUrdhwajathrugata vikaras1a. Acharya’s like Charaka5, Sushrutha6, Vagbhata,Sharangadara7, Kashyapa8 have mentioned detailed description of Nasyakarma. Different types of Nasya have been mentioned in classics, among these byVagbhata Brhmana Nasya is specially indicated for inducing sleep2. For this BrhmanaNasya - Murchitha Gritha (mahisha gritha) is used. Mahisha gritha specially described asNidrajanaka agent9. Gritha itself is a Brhmana dravya and having the properties of madhura vipakaand sheeta virya, which acts as brimhana, after administered through nasal route.Murchita Mahishagritha reduces the doshas like Vata and Pitta and has the propery ofNidrajanaka. Gritha also contains 4-5% Linoleic acid & essential fatty acid, which promotesproper growth of human body. The Lipophilic action of gritha facilitates transportation to “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 5
  • Objectivesa target organ and final delivery inside the cell, because cell membranes also containLipid. Gritha being Yogavahi can be used in other Ayurvedic preparations. In the processof evaluating the activities of natural compounds, it has been found by means ofsophisticated research that when herbs are mixed with ghrita, their activity and utility ispotentiated many times. So, the murchitha gritha is used in this study can be includedunder Brimhana nasya and hence Sarpi Nasya is taken for the management ofNidranasha.(2) To evaluate the efficacy of Yastiksheera Dhara in Nidranasha: Nidranasha leads to the both physical and mental disturbances and even alters themetabolism. Use of anti-depressants and sedatives will lead to lot of adverse effects10.Hence in the present scenario, there is no effective treatment available in other systems ofmedicine. Sleep is one of the essential factors for sustainance of life, hence it has beenincluded under Thrayopasthamba11. Shirodhara is advised for the treatment ofNidranasha, in the context of Murdhini taila which is mentioned by Vagbhata12. Ksheeradhara is commonly practicing procedure for inducing sleep. Yastimadhu drug having the properties of sheeta virya and madhura vipaka, alsoVata and Pitta shamaka13. It is Rasayana, balya, Vrishya, Kanthya, Medhya, Mridurechana Mutrala, Varnya, Jivaniya, Sandhaniya, Chakshushya, Dahashamaka andKeshya. Mahisha ksheera is also specially indicated for Nidranasha by Vagbhata14a, b. Ksheerahaving the properties as Madhura Rasa, Guru, Snigdha, Sara Guna, Sheeta Virya, “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 6
  • ObjectivesMadhura Vipaka, Vata-pitta Shamaka and Karma as Mana Prasadaka, Medhya,Rasayana, Vrishya, Jivaniyam and Nidrajanaka. Continuous pouring (Dhara) of yastiksheera on forehead for particular period of timeinduces sleep and gives tranquilizing effect. This comfort can be compared to theCradling of a mother to her child15. According to modern view, the medicine may passthrough the stratum cornium into the blood vessels or may absorbed on the forehead andreach the brain cortex. The ksheera when penetrates or enters into the circulation acts asvatahara. Hence Dhara karma provides activation to cells by its medhya effect withoutany irritation or harmful effects. By understanding the properties and action of both yastimadhu and mahishaksheera we can conclude that, they are specially indicated for the treatment of Nidranashaand hence Yastiksheera Dhara is taken for the management of Nidranasha.(3) To compare the efficacy of Yastiksheera Dhara versus Sarpi Nasya inNidranasha. A Comparative Clinical Observational Study of Sarpi Nasya and YastiksheeraDhara has been taken up to study the clinical effect in Nidranasha. Thus the trial iscompared at the clinical efficacy with respect to the subjective and objective parameterschosen. At this attempt the group-A and group-B designated with respective therapies ofSarpi Nasya and Yastiksheera dhara respectively, are observed for the efficacy ofNidrajanaka prabhavam. Keeping this in background the study was done to compare “THE EFFECT OFYASTI KSHEERA DHARA AND SARPI NASYA IN NIDRANASHA”. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 7
  • Review of Nasyakarma NASYAKARMAHistorical review:Atharvaveda: “A¹cÉ¢ü lÉuɲÉU .................” (Atharvaveda.10-2-32). Nasa is describedamong nine Chidras and Indriyas.Rigveda: Some Mantras of Rigveda indirectly refers,for the eradication of the rogafrom the routes of Nasa, Chibuka, Shira, Karna and Rasana. (Rigveda.10-16-4).Yajurveda: Nasa is described among the Indriyas, while mentioning of two Netra,two Karna, Nasika Chhidras and Jihva.Bhagavad Gita: “lÉuɲÉU mÉÔuÉÉïSåÌWû lÉåuÉÉ ..................” (Bhagavad Gita 5/13). Nasa isdescribed among the Indriyas.Ramayana: In Valmiki Ramayana, when Laxmana became unconscious by the blowof Meghanada, their Vaidya Sushena administered the juice of Sanjivani throughnasal route and was back to consciousness, instantaneously.Introduction: Nasya or Shirovirechana is considered as the best and the specific Shodhanaprocedure for diseases of the head or the Sira “FkuÉïeɧÉÑÌuÉMüÉUåwÉÑ ÌuÉzÉåwÉɳÉxrÉÍqÉwrÉiÉå” 1.Nasya is a method, where - the medicated Taila or Churna, etc., is instilled in the noseto reach the shiras. Arunadatta16 has defined the word Nasya as “lÉÉxÉÉrÉÉÇ mÉëhÉÏrÉqÉÉlÉqÉÉæwÉkÉÇlÉxrÉqÉç”, it is derived from the root Nas. The word Nas is derived from the Nas dhatu.The Nas is also meant as Nasyakarma. Nasya is very useful in the diseases of upper part of the neck as the Nose isconsidered as the portals of the Head or the Sira- “lÉÉxÉÉÌWû ÍzÉUxÉÉå ²ÉUÇ”1. The medicineapplied through the nose will reach the shiras and mitigate the vitiated doshas. In “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 8
  • Review of NasyakarmaSushrutha samhitha, the word Shirovirechana is used for a Snehana type of Nasya17.As Nasya produces Shodhana of doshas, Virechana shabda is used here. Charaka hasused the word Nastha prachardana18, but Chakrapani views Nastha prachardana asShirovirechana. According to Bhavaprakasha also all drugs and measures that can beadministered through the nasal passage are called Nasya – “iɲÉËU lÉÉxÉÉ mÉårÉqÉç”19.‘Nasya’ also means ‘beneficial to nose’.Etymology of Nasyakarma:In Ayurveda, the word Nasya means the route of administration of the drugs. Nasyakarma as stated by Charaka (Cha.Si.9/88) the nose is the gateway of thehead, by the administration of the drugs through the nose is called Nasyakarma. As stated by Sushrutha (Su.Chi.40/21) the medicines which administeredthrough the nose is Nasyakama. As stated by Arunadatta (AH.Su.20/1) the nose is the gateway of the head andthe administered through the nose is Nasyakama.Also according to Sharangadhara (Sha.Utt.8/1) and Bhavaprakasha (BP.Pur.5/189)stated, the administered through the nose is Nasyakama. (Ayurvedia Shabdakosha)Synonyms: Shirovirechana Shirovireka Murdhavirechana Nastha prachardana “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 9
  • Review of NasyakarmaClassification of NasyakarmaAccording to various Aachaarya: Nasyakarma has been classified in to several types by different Aachaarya.Some are based on the mode of action; some are on the form of administration andsome on the source of the drugs used for the procedure.Charaka’s Classification of Nasya: According to Charaka the Nasya is of five type’s viz. Navana, Avapida,Dhmapana, Dhuma and Pratimarasa20. Navana is further divided in to Snehana and Shodhana, Avapidana into Shodhana and Stambhana, Dhuma into Prayogika, Vairechanika and Sneihika while Pratimarsha is divided into Snehana and Shodhana. Snehana Navana Shodhana Shodhana Avapidana StambhanaNasya Dhmapana Prayogika Dhuma Sneihika Vairechanika Snehana Pratimarsha Virechana “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 10
  • Review of Nasyakarma1. Naavana Nasya: Administration of Sneha into both the nostrils with the help of cotton ordropper is called “Navana nasya”. It is of two types as Snehana & Shodhana20.It gives strength to the Greeva (Neck), Skanda (Shoulder) and Uras (Chest). Itproduces Prasaada of drishti (improves eye sight) 21.Dosage: 22 32 drops - Uttama matra 16 drops - Madyama matra 8 drops - Hraswa matra in each nostril2. Avapidana Nasya: The process of nasal administration by means of fresh juice obtained byexpressing the leaves containing Tikshana Guna is known as “Avapidana Nasya”23.According to Dalhana24, it is of two types as 1. Stambhana and 2. Shodhana Sushrutha explains the Virechana nasya is mainly used for the purpose ofproducing Shodhana in the head. It is useful in Murcha, Sanyasa, Moha, Apatantraka,Apasmara and other Psychic disorder. In other conditions of Pitta diseases, theSthambha variety of nasya is used with Sharkara (sugar), Ikshu rasa (sugarcane juice),Ksheera (milk), Ghritha (ghee) and Mamsa rasa (meat soup).Dosage: 8 drops - Uttama matra 6 drops - Madyama matra 4 drops - Hraswa matra in each nostril3. Dhmapana Nasya or Pradhamana Nasya: 25 a, b Blowing medicated powders into the nostrils with the help of a tube. For this 6angula length tube is used, in which the choorna will be filled and the same choornawill be made to get into the nose by blowing. It is useful in Unmada, Apasmara, Atatwabhinivesa etc. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 11
  • Review of Nasyakarma Dalhana has suggested the use of fine powder taken in a thin cloth in aquantity of Sukti pramana (2 tolas) and tie it in the form of a Potali (bolus) and thesmell should be inhaled.Dosage: Is 3 Muchyuti i.e., approximately one Gunja (the quantity that is being takenwith the help of index finger) 4 rathi - Uttama matra 3 rathi - Madyama matra 2 rathi - Hraswa matra in each nostril.4. Dhuma Nasya: 20 The process of inhaling medicated fumes through the nostrils and expellingthrough mouth with the help of a Dhuma Yantra is known as “Dhuma Nasya”.It is of 3 types 1. Prayogika, 2. Vairechanika and 3. Snehika dhuma 26 aAccording to Chakradatta Dhuma nasya is used in Shiroroga, Nasa roga, Akshiroga.According to Vagbhatta26 b has suggested the use of dhuma through the nose first incase of Utklishta (aggravated doshas in the head) and the dhooma must be taken onlyfrom the mouth. When there is no Utklishta of doshas either in the nose or in the head,then if they are to cause aggravation then make the patient to inhale the dhumathrough the mouth and then through the nose.Dhuma Yantra: Consists of 2 parts are (a) Dhuma Netra (b) Dhuma Varti “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 12
  • Review of Nasyakarma(a) Dhuma Netra: Dhuma Netra can be prepared with the same metals which are indicated forthe preparation of Vasti Netra like Gold, Silver, Copper etc27. Dhuma Netra has thecircumference of a thumb and little finger at the base and tip respectively, the holenear the tip is of the size of a pea.The length of Prayogika Dhuma netra - 48 inches Snehika Dhuma netra - 32 inches & Vairechinika Dhuma netra - 24 inches (AS.Su.29)Preparation of Dhuma Varti: 28Dhuma nasya can be classified into 2 varieties, depending on the method of use.♦ Common method is, take any stick of herbal stem of 12 inches length and soak it in water over night. Then roll a cloth piece and apply the paste of any drugs eg., Eladigana drugs, according to the condition of the disease for about 9 inches and then dry it well. Again apply the same paste and dry. In this way paste is to be applied for 5 times. After that remove the stick from the cloth and the dhuma varti is ready. Then it should be arranged to Dhuma Netra and lit after applying ghee andmedicated fumes are to be inhaled through the nostril.♦ Other method is, the drugs mentioned for nasya are to be kept inside a tube and the tube must be lit with fire. In this type of nasya, the length of the netra Prayogika Dhuma netra - 36 inches Snehika Dhuma netra - 32 inches & Vairechinika Dhuma netra - 24 inches “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 13
  • Review of Nasyakarma The fumes inhaled through the nostrils should be expelled through the mouthand those inhaled through the mouth also should be expelled through mouth only. Thefumes should never be expelled through the nostrils, otherwise complication of theeye sight may arise 26 a, 29.5. Marsha or Pratimarsha: The Marsha and Pratimarsha nasya are to be conducted with the help of Sneha.The Marsha differs from pratimarsha in its high dose and they are to be differentiatedwith the help of dose schedule only20, 23. Pratimarsha nasya produces the dosha Saamyavastha, it won’t produce anycomplications. This is to be given twice in a day.This will not enhance the disease, butproduces Avarodhata in the body. The anguli of the patient must be dipped in sneha and should be dropped intothe nostril in the form of drops. This process is called Pratimarsha. As soon as Snehadropped into the nose it should be inhaled. This can be administered in all the seasonsof the year. The dose of Pratimarsha should be so much that the Sneha must reach thekanta from the nose, but Sneha should not produce any Sraava in the throat 30 a, b.Indication of Pratimarsha Nasya: 31 a, b Any age Any season Baala Vridhdha Bhiru Sukumara “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 14
  • Review of Nasyakarma Kshtakshama Trishna Pidita Mukhashosha Valita and PalitaContraindication of Pratimarsha: 32 a, b Dushta Pratishyaya Krimija Shiroroga Madhyapeeta Badhirya Bahudosha Utklishta DoshasIt is contraindicated, because the Sneha Matra is very less to eliminate Doshas and theaggravated Doshas may get vitiated further.Dose: 2 bindusMarsha: According to Vagbhata dropping of Sneha in the nostrils from 6 to 10 drops isknown as Marsha. Marsha Nasya gives quick result and it is more effective thanPratimarsha Nasya33Dose: 10 drops - Uttama matra 8 drops - Madyama matra 6 drops - Hraswa matra in each nostril “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 15
  • Review of Nasyakarma Table No.01 showing the Time of Administraion 34 a, b, c Ashtanga Sharang- Hridaya dharaNo Time for Pratimarsha Nasya Sushruta 1 After leaving the bed in morning + + + 2 After cleaning the teeth + + + 3 Before going outside + - + 4 After exercise + + + 5 After sexual intercourse + + + 6 After walking + + + 7 After urination + + + 8 After passing Apanavayu + - - 9 After Kavala + + +10 After Anjana + + +11 After meal + + +12 After sneezing + - -13 After sleeping in the noon + + +14 In the evening + + +15 After vomiting - + +16 After Shiroabhyanga - + -17 After defaecation - + +18 After laughing - + -Classification of Nasya according the Pharmacological action. 35 a, b Charaka and Vagbhata have classified the above mentioned five types ofNasya into 3 groups according to their pharmacological action, viz. (i) Rechana (Virechana) (ii) Tarpana (Brimhana) and (iii) Shamana “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 16
  • Review of Nasyakarma Rechana Mode of Action of Nasya Karma Tarpana Shamana1. Rechana Nasya (Virechana Nasya) The Rechana Nasya denotes to eliminations of vitiated Doshas fromUrdhvajatrugata part of the body. Mainly, Tailas and Kashayas are prepared withTikshna Dravyas like Pippali, Apamarga, Maricha, etc.,36 are used for VierechanaNasya. Also these Tikshna dravyas are administered by dissolving into Madya, Asava,Madhu, Saindhava, etc.,37 for the specific diseases.Indications: It is indicated specifically in Kaphaja type of Shiroroga like Manya Stambha,Abhishyanda, Swarabheda, Supti and Shirogaurava 38. Sushruta and Vagbhataindicated for Arochaka, Shoola, Shirogaurava, Pinasa, Pratishyaya, UrdhvajathrugataKaphaja Vikaras 39. Urdhvajathrugata Shopha, Praseka, Vairasya, Arbuda, Dadru andKotha 40. Virechana Nasya prepared in Sneha is particularly indicated for women, weakand delicate persons. Nasya which is prepared in Quatha and Kalka is specificallyindicated for Galaroga, Sannipataja Jwara, Atinidra, Manasika roga etc., If theintensity of the doshas are more in these disorders, then Churna should be usedbecause it enter completely into the nostrils and it mitigates the doshas. 41. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 17
  • Review of Nasyakarma2. Tarpana Nasya (Brhmana): In Brhmana Nasya, Snehas prepared with Snigdha and Madhura rasa dravyas42 a, b are administered. According to Vagbhata, Sneha prepared with Snigdha andMadhura drugs or with the drugs described useful for that particular disease should beused 41. Ghrita itself is a Brhmana dravya and if medicated ghrita with madhura andsheeta virya drugs administered through nasal route, it may acts as Brhmana drug. So,the Medhya Ghrita that is used in this study can be included under Brhmana nasya 41.It is mainly used in conditions like – Mukha sosha, Vaak sanga, Swaropaghata,Manya roga, Apataanaka, Apabahuka, Nidranasha and other diseases of Vata origin.Indications: It is specifically used for Suryavarta, Ardhavabhedaka, Krimi, Dantashoola, 43Karnashoola, Karnanada, Mukasosha, Nasasosha and other Vatapittaja Roga .Sushruta advised the use of Snehana Nasya for Timira, Akshi Samkocha andincreases the vision. It is also used for curing the Shirah kampa, Ardita and VatajaShiroroga 44.3. Shamana Nasya: The Shamana Nasya is defined as that which alleviates dushta doshas situatedin the Shiras and brings it to the normal. In Shamana Nasya the Taila, Ghrita,Swarasa, Ksheera, etc., can be used as per the condition of the patient. The Snehanaand Pratimarsha nasyas will comes under this Shamana Nasya.Indications: It is used to stop bleeding in Raktapitta.45. It is also indicated in Akala Palitaand Khalitya, Darunaka, Raktaraji, Vyanga and Nilika 46. Anutaila Nasya can be used “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 18
  • Review of Nasyakarmafor Svasthya person to promote the functions of eyes, ears and nose also, to preventKhalitya and PalityaClassification of Nasya according to various parts of the drugs: Charaka has mentioned 7 types of Nasya according to parts of the drugs to beused in Nasyakarma viz – Phala, Patra, Mula, Kanda, Pushpa, Niryasa, Twaka 47 as – Phala Patra Mula Various Parts of the Drug Kanda Pushpa Niryasa Twaka1. Phala Nasya: Friuts that are used like Apaamaarga, Pippali, Vidanga, Maricha, Shigru,Shireesha, Ajagandha, Ela, Peelu, Harenuka, etc.2. Patra Nasya : Leaves that are used like Tulasi, Saptaparna, Aragwadha, Moola, Sringaveera,Lashuna, Sarshapa, Taleesapatra, Tamalapatra, etc.3. Moola Nasya: Roots that are used like Arka, Vacha, Alarka, Kushta, Naagadanti, Bharangi,Braahmi, Ativisha, Karanja, Indrayava, etc.4. Kanda Nasya: Stems that are used like Haridra, Shunti, Lashuna, Moolaka, etc. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 19
  • Review of Nasyakarma5. Pushpa Nasya: Flowers that are used like Lodhra, Madhanaphala, Nimba, Saptaparna, Arka,etc.6. Niryasa Nasya: Swarasa (Juice) that are used like Devadaru, Hingu, Agaru, Sarala, Laaksha,Shallaki, etc.7. Twak Nasya: Bark that are used like Guduchi, Ingudi, Tejovati, Daalchini, etc.With the above drugs the Kalka, Choorna, Swarasa, Ksheera, Kwatha, Dhooma, Taila,and Ghritha, etc., can be prepared and used for nasya suitably.Classification of Nasya according to Sushruta : According to Sushruta Nasya is also of 5 types Viz. Nasya, Avapida,Pradhamana, Shirovirechana and Pratimarsha. These 5 types of Nasya are furtherclassified according to their functions into two groups viz. Shirovirechana andSnehana, but Shirovirechana and Avapeeda Nasya have been given separate entity. Shirovirechana is further divided in to Shirovirechana, Avapida andPradhamana, Snehana is further divided in to Pratimarsha and Nasya 48. Shirovirechana Shirovirechana Pradhamana Avapida Nasya Pratimarsha Snehana Nasya “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 20
  • Review of NasyakarmaClassification of Nasya according to Vagbhata: 49 a, bMentioned three types concentrating the action of the Nasya drugs. They are - 1. Virechana 2. Brumhana 3. Shamana Snehana and Brumhana Nasya are further divided in to two groups i.e. Marsha andPratimarsha (according to dose). Aachaarya mentioned ‘Avapeeda Nasya’ separately, which can be used both forShirovirechana and Shamana purposes and ‘Pradhamana Nasya’ which can be used only forthe Shirovirechana purpose. Ashtanga Hridaya50 has mainly classified Nasya in 3 types viz.Rechana, Brimhana and Shamana Pradhamana Virechana Shiro - virechana Pratimarsha Nasya Brumhana Marsha Shamana AvapidaClassification of Nasya according to Kashyapa: According to Kashyapa Samhita Nasya has been classified into two groupsi.e. Brimhana and Karshana. Also, Brihmana Nasya mentioned as Purana Nasya andKarshana Nasya mentioned as Shodhana Nasya 51 a, b “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 21
  • Review of Nasyakarma Brimhana Nasya KarshanaClassification of Nasya according to Sharangdhara: Sharangdhara has also classified Nasya into two groups viz. Rechana andSnehana according to their functions. Rechana Nasya are further divided in to two groups i.e. Avapida and Pradhamana Snehana Nasya are further divided in to two groups i.e. Marsha and Pratimarsha 52. Avapida Rechana Padhamana Nasya Marsha Snehana Pratimarsha Acharya Videha described two types of Nasyakarma according to theirpharmacological action i.e. Sangyaprabodhana and Stambhana. 53 Sangyaprabodhaka Nasya StmabhanaAll these types can be included into the classification of Charaka. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 22
  • Review of NasyakarmaAge limit for Nasyakarma:54 The Age limit mentioned in the classics is between 7 years and 80 years.Aachaarya advices many restriction regarding the Age, Time and Method ofadministration, because the way of drug administration is directly in to the Uttamanga(Head).Time of Nasyakarma:I. Based on Rutu55 Generally,the Nasya should be given in Pravrit, Sharad and Vasanta Rutu. Ifthere is any emergency, some changes can be made and given in other rutu also. If it is Greeshma, advised time is Purvahna (during the early hours of the dayto avoid the harsh Sunrays) arranging a comparatively cooler environment. In Hemanta, it is Madhyahna (in noontime when the temperature will warmup) providing a comparatively warm place for the treatment) and In Varsha Rutu, when there is proper Sunrays (Avoiding Durdina).II. Based on Dosha predominance Table no. 02 showing the Time schedule for Nasya karma in Rogi 56 a, b Dosha Predominance Time of Nasya Kaphaja Vikara Purvahna Pittaja Vikara Madhyahna Vataja Vikara AparahnaIII. Based on Roga Vagbhata has prescribed same timing as Sushruta has mentioned. Nasya canbe given daily in morning and evening in Vataja Shiroroga, Hikka, Apatanaka,Manyastambha and Swarabhramsha. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 23
  • Review of Nasyakarma According to Sharangadhara, if the patient is having Lalasrava, supti, pralapa,shiroroga etc. with excessively vitiated Dosha, Nasya can be administered even in thenight time also57, 56 b.Drug Dosage for Nasyakarma The drug dosage for Nasyakarma is based on the type of Nasya, which is to beadministered. Aachaarya mentioned different dosage patterns for different types ofNasya. Table no. 03 showing the Probable Drug Dosage for Nasyakarma Nasyakarma Dose for each Nostril Avara – 16 drops (8 each) Shamana Nasya Madhyama – 32 drops (16 each) Pravara – 64 drops (32 each) Avara – 8 drops (4 each) Shodhana Sneha Nasya Madhyama – 12 drops (6 each) Pravara – 16 drops (8 each) Avara – 4 drops Kalka Nasya Madhyama – 6 drops (Avapeeda Nasya) Pravara – 8 drops Avara – 2 ratti Pradhamana Nasya Madhyama – 3 ratti Pravara – 4 ratti Avara – 6 drops Marsha Nasya Madhyama – 8 drops Pravara – 10 drops Pratimarsha Nasya 2 drops Churna Nasya 3 pinch According to Videha, the dose for Pradhamana Nasya is 3 Muchut’i (1Muchut’i = the Churna which may come in between Index finger and thumb = 2.4Ratti.) Aachaarya Videha says four drops of Nasya dravya is the smallest dose forShirovirechana. The dose can be increased upto 6 drops, 8 drops, 10 drops or even 16drops also; it should be administered based on the strength of the Rogi and the Roga. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 24
  • Review of NasyakarmaCourse of Nasya Karma: 58 a, b, c According to Sushruta, Nasya can be given repeatedly at the interval of 1, 2, 7and 21 days depending upon the condition of the patient. According to Ashtaanga Samgraha, Nasya should be given for 3 days, 5 days,7 days and 8 consecutive days or till the patient shows the symptoms of Samyak yoga. According to Ashtanga Hridaya explained that one should not exceed morethan seven days. According to Bhoja, Nasyakarma should not perform for more than nine daysas it leads to Saatmyata in the body.Indication of Shirovirechana Nasya The conditions indicated for the administration of Shirovirechana Nasya is inthe diseases of Urdhwajathru gata (head and neck), kaphaja roga, swarakshaya,arochaka, pratishyaya, peenasa, shirah shoola, apasmara etc. According to Charaka59, the conditions like sthambha, supti and shlaishmikashiroroga and also diseases like shiro danta, manya stambha, gala hanu graha,peenasa, galashundika, gala shaluka, shukla roga, timira, vartma roga, vyanga, etc.and Urdhwajatru gata vatadi vikaras60. In Astanga Samgraha40 Aachaarya considered different forms of drugs andalso the condition of the patient while indicating the Shirovirechana Nasya. 1. Sneha Nasya - Bheeru, krisha and sukumara type of persons. 2. Kalka, Choorna, Kwatha, Aasava, Swarasa etc. - In Gala roga, sannipata jwara, atinidra, manovikara, krimi, vishaabhipanna, abhishanna, sarpadashta and visamjna. 3. Choorna – When dosha are excessively vitiated and need quick elimination. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 25
  • Review of NasyakarmaContra-indications for nasya karma:61 a, b, c Bhukta bhakta, ajeerna, peeta sneha, peeta madya, peeta toya, snehaadi peetakama, snata shira, snata kaama, kshudarta, shramarta, shastra danda hata, Vyavaayaklanta, vyayaama klanta, paana klanta, nawa jwara, shokabitapta, virikta, anuvasita,garbini, nava pratishyaya, apatarpita, peeta drava, trushnarta, gara hata, kruddha,Baala, vruddha, vegaavarodita, rakta sravita, sutika, swasa peedita, kasa peedita.Procedure of Nasya Karma: The whole procedure is divided into three stages- Purva karma Pradhana karma Paschat karmaPurva karma: This includes all the preparations and events that are to be done up to instillationof medicine. This stage is further divided into three steps ♦ Collection of materials ♦ Time for administration of Nasya karma ♦ Preparation of the patient♦ Collection of materials: 62 a, b, c, d A Special room should be considered with well ventilated roomwith adequate light for the administration of Nasyakarma and should be named as‘Nasya Gruha’. The Gruja should considered with things like -Nasya peeta or Nasyaasana, Nasya Aushadha, Cotton or Dropper for instillation, spittoon, cloth, attendants,etc. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 26
  • Review of Nasyakarma Nasya can be administered either in the Lying posture or in the Sitting posture.Hence Nasya Asana should be prepared. The main purpose should be to make thehead to lie down in supine position and to make the body in a little elevated posture.♦ Time of Administration: The time of administration of Nasya is to be decided after consideringthe prevailing season and dosha pradanata. For the administration of Nasya karmaSharad(autumn), Vasantha(spring) and Praavrita(Rainy) rutus are useful. The seasonshould not be too cold or too hot or cloudy, in greeshma rutu before madhyanha andin sheeta rutu during madhyanha nasya should be performed.♦ Preparation of the patient: Person to be administered with Nasya karma has to stay in nirvata pradesha,light food is given, after resting for a short duration dantadhavana and dhoomapanashould be done and he should comfortably lie down relaxed on a Nasya chair or cot insupine position, hands and legs stretched straight. Snehana and swedana to face isdone. Swedana is contraindicated to Shiras as it is a marma. Even than for vilayana ofdosha and to facilitate easy expulsion of dosha, mrudu swedana is performed overShiras, manya, nasa, greeva. Eyes are covered with a cloth.63.Pradhana karma: 63, 64 a, b It is of two steps- ♦  Administration of Nasya karma ♦ Precautions taken during administration♦  Administration of Nasya karma Head is slightly bent backwards by keeping a pillow below the shoulder thisfacilitates easy instillation of Nasya medicine. Oil is warmed, nose tip is raised withindex finger of left hand and one nostril is closed with another finger, using right handmedicine is instilled. Exact measured quantity of medicine to be administered is taken “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 27
  • Review of Nasyakarmain a spoon of gold, silver, shell, wood or even administered using a pad of cotton orcloth or a dropper and dropped in a continues flow into each nostrils one after theother. This method is meant to use only either Sneha or Swarasa or Kwatha. If Churna is used for nasya, then it must be introduced into the nose through 6angula netra. From the other end, the powder is blown with the help of mouth.♦ Precautions taken during administration- Quantity of medicine should be exact neither more nor less, it should not bepoured all of a sudden, it should not be too warm or too cold, patients head should bestretched down neither too much nor elevated and he should lie relaxed. During administration of Nasya karma if the quantity of medicine is very less, itwill only excite the doshas, it will not expel doshas out and causes feeling ofheaviness, loss of taste, cough, excessive salivation, rhinitis, vomiting and diseases ofkanta i.e., Ayoga features. More quantity of medicine will give rise to complicationsi.e. Atiyoga features. Pouring the entire quantity at once will force the medicine toenter in to the wrong routes causing diseases of head, pratishyaya, ghrana kleda,obstruction to expiration. If the medicine is very warm it causes burning sensation,formation of ulcers, fever, bleeding through nose, head ache, blurring of vision. If it isvery cold it will cause ayoga features. Medicine instilled in an improperly stretchedposition of the head too gives ayoga features as the medicine fails to spread all overthe head uniformly. If the head is stretched too much, the medicine spreads to a longroute causes moorcha, jaadya, kandu, daaha, jwara. Nasya administered in an un-relaxed person causes increase in doshas as it is unable to spread all over the shiras,along with pain or stiffness64 a. If the head is not stretched than medicine fails to enterinside shiras and if stretched too much than the entered medicine fails to come back65. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 28
  • Review of NasyakarmaPaschat karma: 66 a, b, c, d The patient should avoid swallowing of Nasya aushadhi. Patient should spitout the excessive medicine which has come into the oropharynx. One should avoiddust, smoke, sunshine, alcohol, hot bath, riding, anger, excess fat and liquid diet67.Day sleeping and cold water for any purpose like Pana, Snana etc. should be avoidedafter Nasya Karma68.This has following steps- ♦ Snehana and Swedana ♦ Dhumapana and Gandusha ♦ Assessing the Samyak yoga lakshanas ♦ Complications if any and measures to be adopted♦ Snehana and Swedana Mrudu abhyanga and swedana over gala, kapola, lalaata, mardana overshoulder, feet and hands is done. Patient is instructed not to swallow but to spit theexpectoration as it contains doshas69. Patient should lie still in same position for 100matra kala, should not shake his head, talk, laugh, sneeze, yawn as these prevent themedicine reaching the expected place and even kasa, pratishyaya, shiro akshi rogasmay occur especially if the medicine doesnt reach Shringataka marma and therebymastulunga67, 70. Dhumapana, Kavalagraha and Ushna jala gandusha should be donefor kanta shuddi 66 d, 71.♦ Dhumapaana66 c: Snehana and swedana are nasya purvakarma, by these the srotas becomes softand doshas in them gets loosened. Administration of nasya easily expels them out butthe nasya dravya being a sneha and sneha by nature increases kapha due to its sheetaguna. This retains a portion of kapha, which was liquefied due to snehana and “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 29
  • Review of Nasyakarmaswedana. And so retained kapha cant be expelled out by nasya dravya and getscollected in karna,manya and causes different diseases. To remove this, dhumapana isadministered. Dhuma by virtue of its ushna and teekshna guna clears the dosha70. Inhalation of dhuma is indicated in the disorders of shira72 in general and inparticular prayogika dhuma is indicated after nasya karma73. Two to three inhalations are to be taken through nose and exhaled throughmouth only. If the dhuma is done through the mouth, the fumes should be let offthrough the nose only. By this lightness of head, sense organs, heart occurs, doshashamana takes and throat becomes clear74 a, b.Gandusha:75After dhumapana, ushna jala gandusha is to be done. This removes the kapha presentin the oral cavity and also increases the taste♦ Samyak yoga lakshanas:76 Laghavata (lightness in the body), Nidra (good sleep), Shirolaghuta (lightnessin the head), Sroto shuddhi (cleansing of srotus), Indriya prasannata, Mana prasannataand Roga shamana are the samyak yoga lakshanas Due to Atiyoga - Kaphasraava, Shiro gaurava and Vibrama are lakshanas. Due to Ayoga – Indriya rukshata, Roga aprashamana, Kandu, Anga gauravaand nasa,netra, mukha srava are the lakshanas.♦ Complications if any and measures to be adopted Complications will occur when Nasya is administered in odd times and also tounfit patients. When the complication occurs due to the utklesha of doshas, they mustbe treated with Shodhana and Shamana chikitsa. When the complication occurs due tokshaya, they must be treated with Brhmana chikitsa77. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 30
  • Review of NasyakarmaImportance of Post Nasya Massage: Post nasya massage, recommended by ancient acharya is as important asmassage before nasya. The texts have recommended post nasya massage on thefrontal, temporal, maxillary, mastoid and neck (manya) region. A comfortablemassage on the above regions may help to subside the irritation of the somaticconstriction due to heat stimulation and may also help in removing the slush createdin these regions. According to Sushruta, manya is a marma existing in neck on either side oftrachea78, which likely corresponds to the carotid sinus of neck on the bifurcation ofcommon carotid artery. The receptors called baroreceptors are situated here andmanipulation on it may have a buffering action on cerebral arterial pressure. (Best andTaylor, 1988). Pressure applied on the baroreceptors is also found to normalize thederanged cerebral arterial pressure. - (Hejmadi S. 1985).Probable Mode of Action of Nasya KarmaAyurvedic Point of View: In Ayurvedic classics, the mode of action of nasya karma is explained verybriefly. To understand the mode of action of nasya karma, the following points shouldbe kept in view “lÉÉxÉÉÌWû ÍzÉUxÉÉå ²ÉUÇ” 79• Shringataka marma is a Shiramarma formed by the union of siras (blood vessels) supplying to Ghrana (Nose), Srotra, Akshi (Eye), and Jihva (Tongue), and injury to this marma will be immediately fatal.80• Indu81 has opined that Shringataka is the inner side of middle part of the head i.e."ÍzÉUxÉÉå AliÉqÉïkrÉqÉç". “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 31
  • Review of Nasyakarma• Under the complications of nasya karma Sushruta noted that the excessive eliminative errhine might cause Mastulunga Srava (flow of CSF out of the nose) 82. This suggests the direct relation of Nasal pathway to brain. Considering above points, the mode of action of Nasya karma can beunderstood as follows83. Drug Through nasal route (i.e. gate way to shiras) Reaches the Shringataka Marma (Shiro Antarmadhyam) Spreads through the Shira of nose, ear, eye and tongue Reaches Shiras Enhances the strength of dhatus and tarpana of Shirah Tarpana or Brumhana Nasya 84Modern Point of View: According to modern science, there is no direct pharmacodynamicconsideration between nose and cranial organs. Human brain has strict security system i.e. blood brain barrier (BBB) the noseis used mainly as a route of administration for inhalation of anesthetics material. Inspite of this also, the intra-nasal route for administration of drugs ispreferred by modern science, which is found to be very effective. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 32
  • Review of NasyakarmaA Modern Concept: To understand the pathways of Nasya drug (classical errhine) acting on(central nervous system) it is important to go in details of the modus operandi ofNasya karma. On the basis of fractional stages of Nasya karma procedures, we can drawcertain rational issues that are as follows.A) Effect on neuro-vascular junction: Specific posture during Nasya karma, like the lowering of the head elevationof lower extremities, fomentation of face seems to have an impact on bloodcirculation of the head and face. The efferent vasodilator nerves, which are spread out on the superficial surfaceof face, receive stimulation by fomentation and may increase the blood flow to thebrain i.e. momentary hyperemia. According to Chatterjee, approximately 22% of total dilatation of cerebralcapillaries, caused by facial efferent stimulation will lead to 150% blood inflow(Chatterjee 1980) Considering above description the effect of nasya on neuro-vascular junctioncan be understood as follows mainly by Cushings reaction. So, it can be stated that the modus operandi of nasya karmas has a definiteimpact on central neurovascular system and likely to lower the blood brain barrier,which makes possible the absorption of certain drugs in the brain tissue. B) Effect ct at neuro-psychological levels: Effect of nasya at neuro-psychological levels stand upon the facts discussed previously that the terminal adjacent nerves running along with the olfactory nerves are connected with limbic system of brain including hypothalamus. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 33
  • Review of Nasyakarma♦ Certain drug administered through nose may have an impact on immediate psychological behavior by acting on limbic system through olfactory nerves as the limbic system is also concerned with behavioral aspects of human beings, besides control over endocrine secretions.♦ Cowley, 1975 has also highlighted such phenomenon in his study. The work was carried out by exposing people to known pheromone for a short time period. The result showed subjects reacting differently, in a assessing men and women in comparison with the control state; the judgment of people can also be influenced by exposure to a mixture of short chain fatty acids. These things certainly support the recommendation of Nasya by ayurvedicscholars for mental disorders like Apasmara, unmada and Nidranasha.Absorption and transportation of the drug administered by nasal pathway: Ways for the proper absorption of drug, which is given by nasal route, are asfollows.♦ Keeping the head in lowering position and retention of medicine in nasopharynx help in providing sufficient time for local drug absorption.♦ Lipid soluble substance has great chance for passive absorption through the cell of lining membrane.♦ The drug absorption can also be enhanced by massage and local fomentation. The absorption and transportation of drug, which is promoted by localmassage and fomentation, can occur in two ways.Lymphatic path:Drug can reach directly into the C.S.F. through lymphatic pathway.♦ Along with olfactory nerve, the arachnoid matter sleeve is extended to sub mucosal area of the nose. Correlation between them is established by the “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 34
  • Review of Nasyakarma experiment that the dye injected to arachnoid matter causes coloration of nasal mucosa within seconds and vice versa also.♦ Preliminary studies reported from AIMS laboratorys shows that steroids which are administered as a nasal spray enter rapidly in C.S.F. surprisingly their levels in the C.S.F. was found to be much higher as compared with systemic injections. (Kumar et al, 1979)♦ Here it is important to recall the statement of Sushruta that the excessive administration of virechana nasya (eliminative errhine) may cause oozing of mastulunga (C.S.F) into the nose. On this basis, it can be stated that ancient scholars of Ayurveda were aware ofthe role of lymphatic path in direct absorption into brain from nose. On the basis of the foregoing discussion we can state that the procedures,postures and conducts explained for Nasya karma are of vital importance in drugabsorption and transportation. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 35
  • Review of ShiroDharakarma SHIRODHARA 85, 86, 87 Shirodhara is one of the special types of treatment procedure. It is the processin which medicated oils, milk, kwatha or buttermilk, is poured in a continuous streamon the forehead, for the particular fixed time. Acharya Charaka has defined snehana as the treatment, which producesviscosity, softness, solubility and kleda in the body88. Snehana is one among theshadvidhopakramas. There are two routes to administer the sneha viz. External andInternal. External by Abhyanga, Murdha taila etc. and Internal by Pana, Basti, Nasyaetc. The Murdha Taila is having four varieties namely, Abhyanga, Seka, Pichu andBasti. They are told uttrottara gunaprada89. Dhara can be administered in differentway like Shirodhara or Shiroseka (only on the head), Sarvangadhara (all over thebody) and Sthanikadhara (local). Dhara is not only used in psychic diseases, but alsoused in psychosomatic diseases like psoriasis, Nidranasha. Dhara is done by usingdifferent medicaments like taila, takra, kshira, kwatha etc.Synonym of Dhara: ♦ Dhara ♦ Seka ♦ Parisheka ♦ Avasheka ♦ Sechana ♦ Prasechana “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 36
  • Review of ShiroDharakarmaIndication: 90Shirodhara is effective procedure which indicated in ♦ Nidranasha, ♦ Ardhavabhedaka, ♦ Suryavarta, ♦ Ardita, ♦ Pakshagata, ♦ Hanugraha, ♦ Akshisula, ♦ Shirogatavata, ♦ ShirahkampaContra-Indications♦ Kaphaj Vikaras♦ Shirodhara further increases Kapha, which makes the diseases difficult to cure.Method of Pouring of Dhara:The procedure of Dhara may be divided into three stages for the descriptive purpose:1). Purvakarma2). Pradhanakarma3). Pashchatkarma1). Purvakarma: Purvakarma is the preparation of the patient. First, it should be confirmed thatthe patient is fit for Shirodhara or not. Patients who are suffering from mental illness,headache, peenasa, sankhaka, suryavarta, arumshika, pratishyaya, shiropaka,shirovrana, anidra, timira, karnaroga, akshiroga, valita, palita, murcha etc. diseases arefit for Shirodhara. It is advisable for the better results that the hairs of the patient on “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 37
  • Review of ShiroDharakarmathe scalp should be removed, if the patient permits. The patient should pass stool andurine. Then patient’s pulse, temperature, blood pressure should be recorded. The patient is made to lie down in the wooden basin, specially prepared forsuch kinds of treatment, after first anointing his head and body with suitablymedicated oils. His head rests in a slightly elevated position, preferably on a pillow.The anointing of the oil is generally done, at first by the physician himself and then bythe attendants all over the body. The oils for the purpose should be medicatedaccording to the nature of the disease the patient is suffering from. The eyes and earsshould be covered with cotton so that, liquid may not enter in the eyes. For the treatment two attendants are needed; one for supporting the vesselcontaining the liquid to drip on to the forehead of the patient, and the other forcollecting the liquid that falls from the head of the patient and returning it back to thevessel wherefrom the liquid is to drip.Dharapati or Droni or Dhara table: For Shirodhara a special type of table is used and it is known as Droni. Thetable is made up of wood with raised edges in all the four sides so that the liquid/oilmay not flow out. The first one is the selection of suitable wood for making theDharapati. Many trees as Plaksha, Udumbara, Varana, Nyagrodha, Devadruma,Punnaga, Kapitha, Bakula, Asoka, Amra, Vilwa, Nimba, Khadira or Arjuna. The idealwood universally accepted by the physician is Kupilu (Nuxvomica). In this tablearrangements are made at the head end so that, the liquid poured can be collected inanother vessel and can be re-used.Dimension of Droni: The construction of droni is explained here. It is better wrought from a singlepiece of wood 11 feet 9 inches by 2 feet 9 inches by 9 inches. From either end mark “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 38
  • Review of ShiroDharakarmaoff a length of 9 inches and carve out the four rounded handles near the bottom at thefour corners, each having a diameter of two inches. Leaving a margin of one and halfinches width all round scoop out the whole surface of 10 feet by two feet 6 inchesuntil the margin around stands one and half inches above it everywhere. Then theinner space is divided into two main compartments; the anterior compartment or thehead end having a space of 2 feet 6 inches (including a cross ridge) by 2 feet 6 inchesand the posterior compartment or the body portion having a space of 7 feet 6 inchesby 2 feet 6 inches. A partition ridge is made to separate the anterior compartmentfrom the posterior compartment and also for giving a comfortable seat for the neck ofthe patient during the treatment. The anterior compartment is again divided into two parts; one being a levelplatform 11 inches wide at the farther end towards the head portion and the otherbeing a sloping plane of 1 foot 5 ½ inches wide from the bottom of the partition ridgetowards the head end platform. Here in the head end platform scoop out a circularhemispherical sink of 10 inches diameter and 6 inches depth such that the sinkcommences at a point 2 inches away from the bordering rim at the head end. The sinkshould protrude 1 inch into the slopping part below the head end platform. Thisprojection facilitates an easy flow of the liquid coming down the slope to the sinkfrom the portion near the marginal cross-ridge which separates the head portion fromthe body compartment. The space between the cross-ridge and the circular sink isplaned with a slight slope so that all the liquid drippings from the head of the patientmay drain into the sink. The body compartment is scooped out gradually sloping towards the foot endto a depth of 7 ½ inches at the farther end of the basin where an outlet is bored “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 39
  • Review of ShiroDharakarmathrough the marginal rim to let out wastes ad drippings that may accrue during thetreatment.The anterior compartment and the posterior portion of the basin should be perfectlysmooth and comfortable for the patient. The partition ridge is also rounded off andsmoothened with a concave depression 6 inches long and ½ inch deep in the middlefor a comfortable neck rest. Above Shirodhara portion of the table, dharapatra should be suspended withthe help of a strong wire to enable liquid to fall from the proper height.Dhara Patra or Dhara chatti: Dhara Patra is a vessel in which liquids used for Shirodhara is put in. It isprepared from steel, glass, gold, silver, clay, or any of the woods recommended forDroni. It is a shallow, about 5 or 6 inches in depth, wide-mouthed and curvedbottomed vessel of the capacity of not less than 2 prasthas or 64 ounces. The vessel is to be suspended just over the head of the patient by means ofsuitable cords tied round the rim of the vessel, taking care that the supporting cordsshould never pass underneath the basin. A small hole- just sufficient to admit the tipof the little finger of the patient- about ½ inch in diameter is to be bored neatly at thecenter of the bottom of the vessel. A small hard hemispherical hollow wooden cup,preferably a half of the hard endocarp of the coconut, having a similar correspondinghole in its bottom at its center and corresponding to the hole in the basin and withridged edges is placed over the hole in the vessel with its mouth downwards. A stringof loose cotton threads is passed through the hole of the wooden cup with a free endof about four finger (3 inches) coming out through the hole. The upper end of thethread should have knot to prevent slipping from the vessel. The vessel is kept refilledwith the recollected liquid. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 40
  • Review of ShiroDharakarma2). Pradhanakarma: The selected liquid should be kept in the vessel and be poured continuouslyand slowly on the upper part of the forehead of the patient. A mild oscillation shouldbe given so, as to maintain the flow to all over the forehead. The vessel is kept refilledwith the drippings collected from the sink in the wooden basin in which the patientlies down.Dharakala: The process can be continued for one and half hours; but there are variationsabout the time period among different acharyas. The maximum time for Shirodhara isgiven as one Muhoortha91. The patient is to remain in the lying posture alone (on hisback) throughout the period. This treatment is carried on daily for a period of seven tofourteen days, according to the disease and the physical condition of the patient.Generally the treatment is done in the morning hours, preferably between 7 and 10a.m.Period for Changing the Liquid: When Milk or Buttermilk is used, it should be changed everyday. WhenKashaya is used, it should be prepared everyday. When Dhanyamla is used, it can beused up to 3 days. When Oil is used, it should be changed at 3 days. In the first 3days, half of the oil is used, for next 3 days later half of its used and on the 7th day theentire first and second half are mixed together, then it should be discarded3). Paschatkarma: At least five minutes before the completion of Dhara all attendants should beparticularly vigilant. Everything for the next step, like bath towel, etc., are to be keptready. Refilling of Dhara patra is to be stopped some seconds earlier before the exactstopping time. At the exact time, stop Dhara by drawing the vessel back. Then wipe “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 41
  • Review of ShiroDharakarmathe head with the towel. In Sarvangadhara the body is to be wiped well with the towel.Then the patient may take bath as usual. To remove the oil from the body pastedgreengram, horsegram, etc, can be used. After bath wipe the head without delay. Ithas to be done carefully so that no moisture is retained. After wiping, part the hair andrub the medicated powder like Rasnadi choorna in Murdha pradesha, to prevent theoccurrence of Cold.Pariharyani: The patient should abstain from sexual intercourse as well as from any thoughtor deed that may excite sexual desire, avoid physical exertions, mental excitementsuch as anger, grief etc. and exposure to cold, sun, dew, wind, smoke and dust shouldbe avoided. Riding on elephants or horses, walking, speaking too long or too loud andsuch other acting that may give any strain to the system must be avoided. Sleepingduring daytime and standing continuously for long period must also be avoided. It isalso advisable to use a pillow, which is neither very high nor very low, during sleep atnight. During the course of the treatment, the patient should be also cheerful, happyand should avoid wearisome exertions, distasteful diet or excessive indulgence intasty foods. He should wear clean and dry cloths and may have Lepana ofSandalwood paste. For any reason or due to lack of attention, if any untoward effect isobserved, stop Dhara immediately. Then treat for those Dhara dosha. When suchtroubles are relieved again start Dhara with due care.Dhara-Dosha: If Dhara is done from more height, very nearly or very slowly then it mayproduce burning in the body, pain in the all joints, bleeding tendency, jwara, kotha,headache, etc. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 42
  • Review of ShiroDharakarmaFor the treatment of dhara-dosha following measures may be adopted: i) Gandusha ii) Nasya iii) Kashayapana with Sunthi iv) Light diet at evening, Yusha with black pepper v) On the third day, Basti should be given in which saindhava is mixed. After the Dhara for 7 days or 14 days, the restrictions are reduced graduallyand returning to the normal diet and conditions.85Probable Mode of Action of Shirodhara: The Shirodhara therapy is extensively used for the alleviation of manyailments, especially in psychic ailments but used in some of the somatic ailments too.Though clinical efficacy of Shirodhara is proved, the nature of its action is verycomplex. Therefore, to understand the mode of action of Shirodhara is a difficult task. The mind, body and spirit are intimately connected, and shirodhara by calmingthe stressful mind, relaxes the entire physiology. Imbalance of Prana, Udana andVyana Vayu, Sadhaka Pitta and Tarpaka Kapha can produce stress and tension. Shirodhara re-establishes the functional integrity between these three subtypes of Doshathrough its mechanical effect. Sahasrara Cakra is known to be the seat of pituitary andpineal gland. As we know, the pituitary gland is one of the main glands of theendocrine system. Shiro dhara stimulates the pituitary gland by its penetrating effect,which helps in bring the hormonal balance.The Shirodhara is effective in following two ways: ♦ Therapeutic effect of medicaments ♦ Procedural effect of the process “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 43
  • Review of ShiroDharakarmaTherapeutic Effect of Medicaments: The therapeutic effect is partially attributed to the medicaments viz. themedicated oil, Ghrita, butter milk, Kwatha etc. which exchange through the fine porespresent over the scalp and forehead. As it is said that the effect and potencies of thearticles of Abhyanga, Snana, Udvartana, etc. which are digested by the skin, enter intothe internal organism through the orifices present in the skin92.The concept of percutaneous absorption described in the modern physiology can besummed up as follows: There are three possible routes of absorption. The pilo sebaceous follicles playsome part in absorption of many compounds. The trans-follicular absorption, the routeof penetration is through the follicular pores to the follicles and then to the dermis viathe sebaceous gland. The permeability of the cells of the sebaceous gland is greaterthan that of granular layer of the epidermis (Lovatt Evan’s Physiology, 11th edition).Procedural Effect of the Process: The procedural effect of Shirodhara itself seems to produce a relaxationresponse irrespective of the medicament used. In almost all the methods of relaxationlike yoga, meditation etc. similar general principles prevail. One involves efforts andconcentration focusing attention upon a particular object or sensation and the other asimple watchfulness and observation allowing fine flow of perception. In Shirodhara, patients feel relaxation both – physically as well as mentally.Relaxation of the frontalis muscle tends to normalize the entire body and achieve adecrease in activity of sympathetic nervous system with lowering of heart rate,respiration, oxygen consumption, blood pressure, the brain cortisone and adrenalinelevel, muscle tension and probably an increase in α - brain waves. It strengthens themind and spirit and this continues even after the relaxation. Corresponding to “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 44
  • Review of ShiroDharakarmadifferent levels and powers of consciousness there are different nerve plexuses andglands in human organisms. Special stimulation of different nerve plexus, glands andbrain cells accompanies mental function of different type at different levels. Thus, theHindu theory of Chakras – center of consciousness – is based on this fact. According to Ayurveda, the forehead and head are areas of many vital spots –Marma, which have got very important place in the body. . Marmas are veryimportant points where Soma (Jala/Kapha), Vata, Agni (Pitta), Raja, Satva, Tama andBhutatma’s are present93. In some cases, even slight stimulation of such Marma mayhave beneficial effect on the body, due to their connection with higher centers.Shirodhara makes the patient to concentrate on this area, by which the stability arrivesin the mind function and the patient may feel more comfortable (relaxed). Andmoreover, it is having tridoshahara effect. So, in Ayurveda out of the three types of chikitsa Bahirparimarjana has alsoimportant place and many systemic diseases are cured by using external methods ofthe therapy and Shirodhara carried out with takra is one of them. Shirodhara is donedirectly on the head, so it may be considered as good for relieving the diseases causedby stress and strain as well as other mental factors. According to Yogic science among the seven charkas two are locatedin the head i.e. Ajna chakra and Sahasrara chakra. It can be hypothesized that withDhara therapy these two charkas are getting stimulated and activating thehypothalamus. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 45
  • Disease Review DISEASE REVIEWHistorical Review:Vaidika Kala: In Atharva veda Shaunakeeya shakha, the reference of Nidrajanana given asKarma, while explaining the Maulika siddhanta in Dravyaguna.Upanishads: Four levels of consciousness of the life is stated as Jagratavastha (waking consciousness) Svapnavastha (Dreaming) Susuptavastha (Dreamless sleep) Turiyavastha (Conscious dreamless sleep)(Brhadaranyaka Upanishad, Chandayoga Upanishad and Mandukya Upanishad)Ayurvedic Texts:Samhitha Kala: In Samhitha kala Charaka94, Sushruta95, Bhela and Kashyapa Samhitha96,given descriptions related to Nidra and Nidranasha. Charaka and Sushruta have notdescribed Nidranasha separately. But Bhela97 and Hareeta98 have mentioned specialchapters on Nidra, in this context they explained about the nidana and chikitsa ofNidranasha. In Kashyapa Samhitha, Nidranasha is explained as the lakshana of somediseases and also, as Grahadusta lakshana. Various Aushadhis are also mentioned forthe Chikitsa of Nidranasha. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 46
  • Disease ReviewSangraha Kala: In Astanga Sangraha and Astanga Hridaya the Nidana & Chikitsa ofNidranasha are available. Madhavakara also mentioned Nidranasha as lakshana ofsome diseases.Adhunika Kala: In Bhavaprakash and Yogaratnakara have described Nidana and Chikitsa ofNidranasha and also explained it as lakshana of some diseases. Also in Bhaishajyaratnavali describes some single drugs and variousAushadha yogas for the chikitsa of Nidranasha. In Sharangadhara Samhitha,explained about the Murdhini taila.Etymology: (Shabda Kalpa Druma) Derivation of the word ‘Nidra’♦ Root Ni + dra + rak + ta = Nidra ( Amarakosa)Ni + dra for blem (Panini Unadi 2.17)The word Nidra is formed by the prefix Ni + dra + rak + ta. It is always used infeminine gender. Sleep is a state of unconsciousness of the person.Review of Nidra:Impotance of Nidra:♦ The Acharya of Ayurveda consider the Nidra as one among the three pillars of lifei.e Ahara, Nidra and Brahmacharya99 and also as one among the thirteen AdharaneeyaVegas100.♦ Acharya Vagbhatta explained as one among the three pillars which gives supportand strength to the life.101a, b♦ Nidra is a Swabhava bala pravrtta roga i.e., natural phenomenon102 a, b “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 47
  • Disease Review♦ The happiness, nourishment, strength, virility, knowledge and life depends on theproper or adequate sleep103.♦ Charaka has called the Nidra as Bhuta Dhatri i.e., which occurred by nature ofnight, that nourishes all the living beings104.♦ Sushrutha terms as Vaishnavi i.e., derived word from Lord Mahavishnu, which asrestorative property both physically and mentally105.♦ Like Ahara the adequate sleep is essential for maintenance of the body106.♦ The Characteristic of a healthy individual is proper sleep time and awakening107♦ Bhavaprakasha has described importance of sleep in fetal life. He has emphasizedthat the fetus in the womb enjoys better rest and comfort when the mother sleepsduring pregnancy108.Definition of Nidra:♦ Nidra is the state of life where, gnanendriyas and karmendriyas are not doing theirfunctions109.♦ Sharngadhara mentions that Nidra is a state where predominance of Kapha andTamas is seen110.♦ Dalhana states that Nidra is the state of combination of mind and intellectual inwhich the person feels happy (Dalhana on 1st Chapter).♦ According to Haritha samhitha the Nidra is a state of the body at rest111♦ According to the Patanjali yoga sutra, Sleep is a state of unconciousness. (1/10).♦ Nidra is the state of life where Jnanendriaya and Karmendriaya are not doing theirfunctions (Sabdastoma Mahanidhi). “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 48
  • Disease ReviewAyurvedic Concepts: The three concepts which explained the phenomenon of Nidra by ourAcharyas are as follows,(1) Tamoguna theory:♦ Sushruta explains phenomenon of nidra by giving importance to Hridaya which isconsidered as Chetana Sthana. Tamas predominates during the night and isresponsible for the induction of sleep. When Chetana Sthana is Hridaya and if it isover come or enveloped by Tamas, the person goes to sleep112.♦ Vagbhata states that at night, Tamas being predominance and the higher psychiccenters being over powered by it, and then the sleep initiates113.♦ According to Kashyapa the Satvaguna is Prakashaka (brightening), Raja guna isPravartaka (promoter) and Tama guna is Niyamaka (controller). So predominance ofTamoguna than Satva and Raja is the prime cause for sleep114.♦ Harita has stated that the center of sleep is in the upper half part of nasal region, i.e.,in between the two eye brows and when the Tamas reaches to this particular centerthe knowledge and the activity get diminished and sleep initiates.115.(2) Kapha Dosa Theory:♦ Sushruta mentions that when the Sanjavaha srotas are filled with Kapha andIndriyas are deprived from their respective objects of senses, the person goes tosleep116.♦ Sushrutha also mentions the role of Kapha and Tamo bhava for Nidra.117.♦ Astanga Hridaya describes that whenever the sensation conveying the channels ofthe body are blocked or filled up by the Shleshma and when it is over saturated withthe Tamasika quality the living being gets sleep.118 “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 49
  • Disease Review♦ Bhela explains that Kapha situated in Hridaya is augmented during the process ofdigestion of food, during day time and when covers the Chakshuvaha and SrotovahaSrotas, it leads to sleep119.(3) Fatigue theory:♦ Charaka states that due to exhaustion of the mind, sensory and motor organs willcause inactive and the person goes to sleep109.♦ Vagbhata gives importance to the Kapha Dosha and Shrama of the Indriya andManas in the normal onset of sleep120.(4) Swabhava:♦ Charaka and Sushruta have mentioned as sleep is a nature instinct, the night servesas a causative factor for sleep109, 116.Types of Sleep:Broadly, sleep can classified into 2 types as (1) Svabhavika Nidra – which comes regularly and naturally at night. (2) Asvabhavika Nidra – which comes due to some other causes.Various Acharyas have given various opinions regarding the types of sleep. Othertypes of sleep according to different Acharyas are as follows:(1) According to Acharya Charaka 121 (a) Tamobhava (b) Shleshmasamudbhava (c) Manasika Shrama Sambhava (d) Shareerika Shrama Sambhava (e) Agantuki (f) Vyadhyanuvartini (g) Ratri swabhava “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 50
  • Disease Review(2) Acharya Sushruta classifies as follows:116 (a) Tamasi (b) Swabhavika / Vaishnavi (c) Vaikarika(3) Vagbhata’s classification of sleep is similar with Charaka’s classification butthe names differ.122 (a) Tamobhava (b) Kaphabhava (c) Chittakhedaja (d) Dehakhedaja (e) Agantuki (f) Kalasvabhava (g) Amayaja♦ Vyadhyanuvartini In some diseases due to severe weakness the patient falls asleep calledVyadhyanuvartini e.g., Sannipataja Jvara.♦ Agantuki Chakrapani and Gangadhar commented as Agantuki Nidra is indicative of badprognosis which leading to definite death (Arista lakshana) 121. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 51
  • Disease ReviewCONCEPT OF NIDRANASHA (INSOMNIA):Ayurvedic Review Nidra is not only an important to our life but also an essential phenomenon oflife, which affects the body and mind equally in a favorable way when it is enjoyed ina rightful manner. But it affects adversely, if it is not enjoyed in an appropriatemanner and at appropriate time. The ancient Acharyas of Ayurveda considered Nidra – among the threeUpastabhas for the maintenance of the living organism123. While discussing aboutNidra and Nidranasha in the context of Astauninditiya Adhyaya, Acharya Charaka hasstated that happiness and sorrow, growth and wasting, strength and weakness, virilityand impotence, the knowledge and ignorance as well as existence of life and itscessation depend on the sleep. According to him, Nidra is Pushtida and Jagarana(Nidranasha) does the Karshana of the body. Untimely and excessive sleep andprolonged vigil take away both happiness and longevity, like the night ofdestructions124. Charaka included the Asvapna in 80 Nanatmaja Vata Vikaras125. AcharyaSushruta126 explained this under the chapter Garbha Vyakarana Shariram, might bebecause of Nidra plays a role of nutrition and development of the body. He alsoexplained the Vaikariki Nidra in the same chapter, which can be correlated to sleepdisorders. Acharya Vagbhatta in Ashtanga Sangraha127 mentioned this in Viruddhanna-vignaniya Adhyaya, where he explained the Trayopastambhas. Here he consideredManda Nidra due to Vata, but used Asvapna term in Vataja Nanatmaja Vikaras. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 52
  • Disease Review In Ashtanga Hridaya128, Nidra, Nidra Vikaras and its Chikitsa are mentionedunder Anna-rakshadhyaya, where Trayopastambhas are explained. Acharya Sharangadhara129, concerted the Anidra in Vataja Nanatmaja Vikara,Alpa nidra in Pittaja Nanatmaja Vikara and Atinidra under Kaphaja NanatmajaVikara. By observing these descriptions regarding Nidra and Anidra, it can beconcluded that all Acharyas considered the importance of Nidra, hence Nidranashaare explained along with physiology of Nidra only. Anidra or Alpa Nidra is seen inmany diseases as a Lakshana and it may be Upadrava or Arishta Lakshana also.Hence, the Nidana, Samprapti and Chikitsa are explained regarding Asvapna, theAcharyas considered its independent manifestation too as a disease.The Deprivation of Word Anidra: It is composed of two words ‘A’ + ‘Nidra’. The suffix ‘A’ provides negativemeaning to the act of Nidra. Anidra means less or no sleep. Ayurvediya Vishvakosha part I explains Anidra as Nidranasha. In Ayurvedic texts the term “Anidra” is used indicating a pathologicalcondition in which patient is devoid of sleep.Definition of Nidranasha: The word Nidranasha is composed of two words, Nidra and Nasha. Thedefinition of Nidra is as follows, “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 53
  • Nidana Nasha in other words being lost, elimination, disappearance, annihilation,destruction. Based on the above descriptions, the term Nidranasha can be broadly defined asthe Loss of sleep or Absence of sleep or Destruction of sleep or Derangement in thequantity and quality of sleep.Synonyms of Anidra: Table no.04 showing the Synonyms of Anidra Asvapna Alpanidra Anidra Akala Nidra Avyavahita Nidra Nidra Nasha Nidra Kshaya Nidra bhanga Nidra pranasha Nidraghata Nidra viparyaya Nastha Nidra Nidra alpata Manda NidraNidana 130 a, b, c, d, e, f The causation of Nidranasha are predominantly Vata vitiating factors. Regardingcausative factors for Nidranasha, there is no direct reference.Broadly, the etiologicalfactors of Anidra can be categorized in two headings, viz. Shareerika and Manasika ♦ Shareerika Dosha – Vata bahula, Pitta and Kasheena Sleshma ♦ Manasika Dosha – Satwodarya, Rajas and TamasAcharyas explained some other causative factors due to Ahara, Vihara, Manasa,Upachara, Vyadhi, etc are shown in this table “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 54
  • Nidana Table no.05 showing the Nidana of Nidranasha Ahara Vihara Manasa Upachara Vyadhi / AnyaRukshanna Ati Vyayama Chinta Atiyoga of DhatuSheetanna Adyasana Shoka Vamana kshayaAthyashana Plavana Krodha Virechana AbhighataVishamashana Atyadhwa Bhaya Nasya Kshaya Pradhavana Raktamokshana Kala Pratarana Dhuma Atyuchabhashana Swedana Balavadvigraha Vegodeerana Abhigata Bharaharana Dukhashayya Sheegrhayana Prapeedana Prajagarana Atiadhyayana Ati vyavaya Vegadharana Vishamopachara Shrama Upavasa/Langhana Divasvapna Pavanatapa Himatapa 131 ♦ Acharya Charaka Specifically mentioned the cause for Manasa Vyadhis asis caused by non-fulfilment of desires and facing of undesired. ♦ Acharya Vagbhatta has mentioned the mental cause for Anidra. In AshtangaHridaya, he stated that due to excess of Kama, Nidrakshaya occurs132. 133 Besides this, certain specific causes for Anidra are also mentioned Purgation,evacuation of head, emesis, fear, anxiety, anger, smoking, physical exercise (excessive),blood-letting (excessive), fasting, uncomfortable bed, predominance of Satva and “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 55
  • Nidanasuppression of Tamasa – These check the unwholesome and excessive occurrence ofsleep. These factors may be taken as causes of Nidranasha, along with over work, time,disorder (Vatika), constitution (Vatika) and aggravation of Vata itself. ♦ According to Acharya Sushruta, Nidranasha is caused by aggravated conditionsof the bodily Vayu and Pitta, as aggrieved state of the mind, wasting of Dhatus andtrauma (physical or mental).134 The loss of sleep is not found in all Vata rogas, but it is found in those diseaseswhere the Shula (pain) exists, viz. Pindikodveshtana (cramps), Gridhrasi (sciatica),Udavarta (flatulence in stomach), Akshepaka (convulsions). From Manastapa – all the psychic conditions – like worry, anger, mania etc. canbe taken. ♦ According Vagbhatta in both Ashtanga Hridaya135 and Sangraha136 added somefactors asThe excessive hunger, thirst, mental and physical misery, excessive happiness, sadness,coitus, fearness, anger, worry, eagerness and excessive use of moisture, less dietetics arethe extra causes mentioned for sleeplessness. The Vata and Pitta provoking Ahara andVihara also cause sleeplessness. In Ashtanga Hridaya, the edge of Tikshna Anjan andDwadashavidha Langhana are also mentioned as the causes for Anidra. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 56
  • Purvarupa & RupaPurvarupa: Purvarupa of Anidra is not mentioned in any Ayurvedic classics. As Charakaincluded the Nidranasha in 80 Nanatmaja Vata Vikaras, we can consider “AurÉ£Çü sɤÉhÉ iÉåwÉÉÇ mÉÔuÉïÂmÉÍqÉÌiÉxqÉ×iÉqÉç |”137Charaka has mentioned that Avyakta lakshana are the purvarupa of vatavyadhi.Rupa: In Ayurvedic classics some symptoms are mentioned as. Table no.06 showing the Rupa Rupa Charaka Sushrutha Ashtanga Ashtanga Hrudhaya Sangraha Jrumbha + + + + Angamarda + + + + Tandra + + + + Shiroroga + - - - Shirogaurava - + + + Akshigaurava + + - - Jadya - - + + Glani - - + + Bhrama - - + + Apakti - - + + Vataroga - - + + Charaka has described the following symptoms.138By suppression of sleep, yawning, body ache, drowsiness, head disorders and heavinessin eyes are caused. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 57
  • Samprapti Sushruta has described following symptoms due to restraint of sleep: 139Yawning, body ache, stiffness in the body, head and eyes and drowsiness are thesymptoms caused by restraint of sleep. Vagbhatta has mentioned that due to Nidranasha140 a, b – malaise, heaviness inhead, yawning, laziness, languor, giddiness, indigestion, stupor and Vatajanya rogas willbe manifested.Samprapti: Nidranasha is not explained as a separate disease in Ayurveda. On the basis ofDosha, Dushya, etc. involvement, Samprapti can be constructed. Nidranasha is explainedas Vataja Nanatmaja Vikara. Relation of various Manasika Bhavas regarding the body humors is well known.Hence, Acharya Charaka141 mentioned it as, the interplay between the body and mind isthe core of Samprapti of every Manasa roga. Even though, it is Vataja Vikara, in thepathogenesis of Anidra, the Manasika dosha plays an important role. The etiological factors of Anidra can be categorized in two headings, viz.Shareerika and Manasika. The former category comprises Shodhana Atiyoga, Vyayama,Upavasa, dietary articles and routine activities causing Vata-pitta vitiation etc. Gunas likeRuksha and Laghuguna causes vata predominant, Ushna and Teekshna causes pittapredominant. On account of mental dispositions such as Chinta, Krodha, Bhaya andShoka, Vata Prakopa takes place in addition to the physical factors. The Vata vitiationoccurs, due to both kinds of etiological factors. So the vitiation of these factors leads tothe condition of Nidranasha. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 58
  • Samprapti Nidranasha NidanaAharaja, Viharaja and Manasika Anya Vata ↑ Satva ↑ Pitta ↑ Raja ↑ Kapha ↓ Tama ↓ Kaphakshaya Tamakshaya Lack of Sleshma or Tama avarana to Chetanasthana Hridaya or Samjavaha srotas Nidranasha“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 59
  • SampraptiTypes of Samprapti: Sankhya: According to our ancient Acharyas, Asvapna is of two types viz.,Nidranasha due to Vataprakopa and Nidralpata due to Pittaprakopa142. So SankhyaSamprapti of Anidra can be two in number. Vikalpa: In Anidra, mainly Vata Prakopa occurs and its Chala and Laghu Gunavitiate, which keeps the mind active, causing Anidra. Pradhanya: In Pradhanya Samprapti, the predominance of morbid humors aredescribed in terms of the comparative and superlative degrees but here as Anidra is aVataja Nanatmaja Vyadhi, vitiation of Vata only takes place. So there would not bePradhanya Samprapti in the case of Anidra. Bala: Bala of Asvapna can be determined by the strength of manifestation of itssymptoms, severity, duration etc. Kala: It is an important factor, while considering Nidra as well Anidra. AsAcharya Charaka has mentioned Kala under the causative factors of Anidra, whichindicates that Kala – time factor has an influential effect on it.Samprapti Ghataka Dosha : Vata & Pitta (Vriddhi), Dushya : Rasa Agni : Jatharagni Srotasa : Manovaha, Rasavaha Srotodushti Prakara : Atipravritti Adhisthana : Hridaya Udbhavasthana : Hridaya “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 60
  • Samprapti♦ Dosha: Dosha involvement in Anidra are Vata, Pitta and Kapha. But the deviation fromthe normal level is to be considered with due importance. Vata and Pitta are in increasedstate, while in case of Kapha, the Kshaya is usually observed.♦ Dushya: Rasa Dhatu, has its role in the Dhatu level of Samprapti. Because it providesTushti, Prinana – both functions are evaluated by Acharyas in the psychic level.♦ Agni: Here, vitiation of Jatharagni takes place, because Nidra is said to enhance theAgni 143. Apakti – one symptom of Nidranasha also indicates its vitiation.♦ Srotasa: The role of Manovaha Srotasa can be understood without any controversy.Rasavaha Srotasa, in this context, too have a pivotal role in the pathogenesis. Root ofManovaha Srotasa is Hridaya and Hridaya is substantiating to the seat of Mana.Moreover, etiological factor, responsible for Rasavaha Dushti, includes mental causesuch as Chintyanam Chatichintanat.♦ Srotodushti Prakara: The main mode of vitiation is Atipravritti. Since, the overindulgence of Manasa is a common feature of the disease.♦ Adhisthana and Udbhavasthana: Hridaya is the abode for these two factors. It is theplate form where the whole Samprapti process is supposed to be eventualised. As seenearlier, Hridaya is the bed rock for Mana and its role in Anidra is already defined byAcharyas. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 61
  • Upashaya & AnupashayaUPASHAYA & ANUPASHAYA:Upashaya and Anupashaya are not available in Ayurvedic texts, can be evolved as, Upashaya - Mamsarasa, Madya, Ksheera and Ksheeravikaras, Abhyanga,Utsadana, Tarpana and Snehasevana, etc. can be considered as Upashaya of Nidranasha Anupashaya - Rukshanna, Yavanna, Dhoomapana, Krodha, Shoka, etc. can beconsidered as its Anupashaya.Upadrava:In Ashtanga Sangraha, it is mentioned that increased Vayu due to Nidranasha producesKaphakshaya, this decreased and dried Kapha sticks in the walls of Dhamanis and causesSrotorodha. This, results in so much exhaustion that eyes of the patient remain wide openand watery secretion from eyes. This dangerous exhaustion is Sadhya up to three days,and then becomes Asadhya144.Chikitsa: 145 The Chikitsa of any disease in simple word is: The giving up of the causativefactors. In the treatment of Anidra, one should depend upon the measures havingVatashamaka, Vedanashamaka and Roga Nivaraka effects as well as pacifying effects onmental activities. The treatments which are described for Anidra in Ayurvedic Samhitasare mostly same. The management modalities according to various classics can beclassified as “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 62
  • Chikitsa♦ Bahya upachara♦ Ahara upachara♦ Manasika upachara♦ Anya upachara are as follows,Bahya Upacharas for Nidranasha Charaka mentioned Abhyanga,Utsadana,Samvahana, Abhyanga, Akshitarpana, ShiroLepa, Karna Purana, Shiro Basti, Shirodhara, Moordhni Taila as bahya upacharas.Manasika Upacharas for NidranashaCharaka mentioned Manonukula vishaya grahana, Manonukula sabdagranaha, Manonukula gandha granaha, as manasika upacharasAahara Upacharas for NidranashaCharaka mentioned Gramya mamsa rasa, Anupa mamsa rasa, Jaleeya mamsarasa, Mahisha ksheera, Peeyusha, Morata as manasika upacharasAnya upachara Some other measures, which can be advised to the patient of Nidranasha, thoughare not mentioned in Ayurvedic texts, are as follows:• Maintaining regular time for going to bed.• Avoid smoking, tea, coffee or alcohol at night before going to sleep.• Not indulge in any type of work or reading till late night.• Should devoid of thoughts tensions before going to bed.• Hearing soft music or favorite songs also induces sleep.• 5-10 minutes mediation before going for sleep.• Offering prayer before sleep. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 63
  • Chikitsa• Washing of hand, feet and face before goes to sleep.• Avoiding a divaswapna• Proper evacuation of stool and urine.• Avoid mosquito bites.• Maintenance of adequate privacy and free from disturbance.Ekamulika prayoga: Table no.07 showing the Ekamulika prayoga in Nidranasha Brahmi Katu tumbi Kusmanda Aswagandha Jatiphala Yamini Drakshya Apamarga moola Pippali moola Bhanga Khas khas Sarpagandha Shankapuspi Kupilu Punarnava Jatamamsi Tagara Karpura Raja sarshapa, etc Parasika yavaniOther Yogas: • Brahmi powder or mixed with the sweet drink form • Sankhapushpi powder or in the sweet drink form • Ashwagandha powder 3gm + Pippalimula powder 3gm. Mixture of these to be given twice a day with milk. • Ashwagandha powder 2gm + Pippalimula powder 2gm + Parasikayavani powder 2gm mixed and to be given with milk or water at night before sleep. • Loknath Rasa (Sh.Sam.) • Ashwagandha Churna with Sharkara & Ghee (Vangasena) • Decoction of Jeevaniya Gana with milk (A.S) “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 64
  • Pathya & Apathya • Pippali Moola Churna with Jaggery (B.P.) • Roasted Vijaya powder with honey (B.P.) • Sarpagandha powder – 2gm with milk twice/thrice daily • Decoction of root and bark of Kakamachi with Jaggery (B.P.) • Nidrodaya Rasa (Rasatarangini) • Kalyanaka Guda (Ch.Kal.7)Some external treatment are also described as • The bandanging of the root of Kakamachi or Kakajangha or Apamarga or Kokilaksha or suparnika (Bakuchi) with hair (Ha.Sam.& B.P.) • Maharshi Harita has stated that sleep is induced by the moving wind with the help of cloth, Bamboo-chip (fan) or use of bronze vessel and the use of banana leaf (Ha.Sam.). • He also mentioned that the sleep can be achieved by hearing the sounds produced by the animals like ox, horse etc. and by viewing dance and by hearing humorous words (Ha.Sam.).Pathya – Apathya: Pathya is the wholesome regimen which does not impair the body system andwhich is pleasant to the mind146. If one follows certain principles and controls theactivities and makes changes in the regimen, as mentioned earlier in the form of Aharaand Vihara management, he can get a sound, normal and good sleep. Apathya – those which adversely affect the body and mind are considered to beunwholesome (Apathya). It may be said that etiological factors of Anidra are Apathya inthe disease, because they increase the disease. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 65
  • Modern Review of InsomniaConcept of Sleep:Introduction: Shakespeare described sleep as “Chief nourisher in life’s feast” Sleep is a fundamental aspect of all human life. Sleep comprises approximatelyone-third of our lives. The alternating pattern of waking in the daytime and sleepingduring the darkness of night is so ingrained in human experience that we barely have aperspective on it. Sleep is a state of control and complexity. An excellent night of sleepcan make a person feel wonderful and productive. We do not know why we sleep, just as we don’t know why we are awake.Reasons typically given for sleep include - conservation of energy, the restoration ofimportant bodily functions, and the repair of damaged tissues. For example, somehormones are secreted mainly during sleep. Such theories are attractive, but all of thesefunctions could be met by simply resting and having whatever hormones are secretedduring sleep secreted during rest, not necessarily having the brain go into an unconsciousstate. A poor night of sleep or insufficient sleep leaves a person feeling exhausted andnonproductive; he or she may even pose a danger to others. If people do not sleep theright amount, they feel rotten the next day, their brains do not work properly, and theymight be quite mentally impaired and unable to perform complex tasks.Definition of Sleep:♦ A state of unconsciousness from which the person can be aroused by sensory or otherstimuli147.♦ A state of consciousness that differs from alert wakefulness by loss of critical reactivityto events in the environment with a profound alteration in the function of brain148. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 66
  • Modern Review of Insomnia♦ Sleep is a reversible behavioral state of perceptual disengagement form andunresponsiveness to the environment149.♦ Dr. Robert MacNish wrote in Philosophy of Sleep in 1830 describes sleep as,“Sleep is the intermediate state between wakefulness and death: wakefulness is regardedas the active state of all the animal and intellectual functions and death as that of theirtotal suspension.”♦ A condition of the body and mind, such as that which normally recurs for several hoursevery night in which the nervous system is inactive, the eyes closed, the postural musclesrelaxed and consciousness partially suspended150.♦ A state of natural unconsciousness during which the brain’s activity is not apparent, butcan be detected by means of an electroencephalogram. (Medical dictionary)♦ Insomnia is defined as repeated difficulty with the initiation, duration, maintenance, orquality of sleep that occurs despite adequate time and opportunity for sleep that results insome form of daytime151. A turning point occurred in the twentieth century, when it became apparent thatthe brain was indeed active during sleep. In 1928, a German doctor, Hans Berger,successfully measured and recorded electrical activity from the sleeping brain throughelectrodes placed on the scalp. This was the first EEG (electroencephalogram). Soontechniques were devised to measure the millionths of volts of electrical energy put out bythe human brain during sleep to provide a more accurate picture of the brain’s activity. In 1953 at the University of Chicago, Nathaniel Kleitman and his student, EugeneAserinsky, measured the EEG and eye movements in babies. They described becameknown as rapid eye movement (REM) sleep. Scientists then realized that there were three “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 67
  • Modern Review of Insomniastates of being: non-REM sleep, REM sleep, and wakefulness. It was soon discoveredthat REM sleep is the time when one is most likely to experience vivid dream imagery. Further studies then ascertained that there were actually several types or stages ofsleep. Using brainwaves and other measures, non-REM sleep was divided into fourstages. Typically, as one goes from stage one to four, brainwaves become progressivelyslower and the size of the brainwaves become increasingly bigger and sleep is deeper anddeeper. Stages three and four are frequently combined and called slow-wave sleep, deepsleep, or even delta sleep. Consequently, a more detailed picture of the brain’s electricalactivity during sleep emerged - one that represented the states and stages of sleep duringthe sleep cycle.States and Stages of Sleep Sleep is defined electroencephalographically and behaviorally by two states: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. NREM sleepis characterized by four sleep stages (1–4), with increasing arousal thresholds correlatingwith successive sleep stages. Brain activity as measured by the electroencephalogram(EEG) demonstrates relatively slow synchronous waveforms1, and predominance ofstages 2, 3 and 4, usually called slow-wave sleep (SWS) or NREM. REM sleep, bycontrast, is identified in activation by EEG criteria, relative muscle atonia and episodicbursts of rapid eye movements. REM sleep tends to cycle every 90 to 120 min throughoutthe night becoming more prominent in the early morning hours1,2. The abundance oftheories about the nature of sleep and especially about its function is the best evidence ofhow little we know about sleep–wake mechanisms. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 68
  • Modern Review of Insomnia Figure no.01 Showing the States and Stages of Sleep People are most likely to have heart attacks during their sleep early in themorning. Systemic arterial blood pressure falls by about 5–16% during NREM andsignificantly fluctuates in REM sleep. Cutaneous, muscular and mesenteric blood flowshow little change during NREM but have profound vasodilatation in REM sleep.Cerebral blood flow and cerebral metabolic rate for glucose and oxygen decrease by 5–23% in NREM but increase by up to 41% above waking levels during REM sleep “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 69
  • Modern Review of Insomnia Table no.08 showing the Physiological variability between NonRapid Eye Movement (NREM) and Rapid Eye Movement (REM) sleep Functions NREM REMElectroencephalogram Slow waves(theta and delta) Low amplitude; tooth wavesEvoked potentials None Decreased amplitudeEye movements Slow, pendulum-like Rapid eye movements(electroolfactogram)Chin electromyogram Normal Significant decrease or absenceMono-synaptic reflex Normal WeakPupils Normal MyopicBabinski symptoms Apneas DisappearIntra-cerebral pressure Decreases IncreasesBody movements Typical AbsentBrief finger movement Not typical TypicalArousal threshold Increases DecreasesType of thinking Realistic thoughts Emotional imagesDreams Rare FrequentSleep talking Understandable; long, Not understandable, brief, frequent rare Decreased lowest during Short increases possible (40Blood pressure stages 3 and 4; reduced mmHg); magnitude of variability change greater in hypertensive patients Decreased; breathing Increased variability; burstsHeart rate variablity of eye movements accompanied by brief tachycardia, followed by bradycardia Reduce cardiac output; Transient vasoconstrictionsCardiac activity vasodilatation in skeletal muscle circulation; cardiac arrest (during sleep) more frequent during this stage Twenty-five per cent Significantly increasedCerebral blood flow reduction of flow to blood flow, especially to brainstem; 20% reduction to cochlear nuclei cerebral cortexTemperature Decreased brain and body Increased brain temperature; temperature (rectal) absence of thermoregulationPerspiration (except palms) Maximal Fluctuates by waves “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 70
  • Modern Review of InsomniaFever Increased DecreasedPalms perspiration Decreased Increases during REM burstsSkin galvanic response Increases with body Decreased(SGR) movementsSeizure activity Increased Suppressed Respiratory rate decreased Breathing rapid and may beRespiration upperairway muscles may irregular be hypotonic; obstructing oxygen flow in patients with sleep apneaOxygen Metabolism Decreased Significantly increasedBlood CO2 consumption Maximal Lowest Growth hormone and ACTH-cortisol rhythmEndocrine functions prolactin increased (in the morning) secretion increased Decreased urine volume, VariableRenal function excretion of sodium, potassium, chloride and calciumPain Decreased receptor activity Decreased pain at level of to noxious tactile stimuli tooth pulpDifferent Theories of NREM/REM sleep regulation149: The anatomic and physiological processes that control NREM and REM sleep arenot clearly understood. Currently, the regulatory mechanisms of NREM sleep arebelieved to reside within diencephalic structures, while those regulating REM sleepappear to reside mainly in the pontine brainstem. Although the exact mechanisms controlling NREM and REM sleep are still notclear, several theories of NREM and REM sleep regulation have been proposed.♦ In the 1970s Jouvet proposed the monoaminergic theory of the sleep–wake cyclebased on pharmacological and brainstem transection studies. Jouvet’s theory suggestedthat the catecholaminergic system of the brain plays the executive role in REM sleep. Thecaudal two-thirds of the locus ceruleus (LC) complex (locus ceruleus, subceruleus and “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 71
  • Modern Review of Insomniaparabrochialis) act as the trigger for REM sleep. One-third of the LC complex controlsthe total inhibition of muscle tone, whereas the medial third of the coeruleus complex isresponsible for pontogeniculo-occipital (PGO) activity and both phasic and toniccomponents of REM sleep.♦ The contemporary version of the monoaminergic theory is Hernandez-Peon’scholinergic theory of sleep–wake regulation. According to this theory, the sleep–wakecycle is regulated by two antagonistic cholinergic systems: the sleep system and thewaking system. Recently Jouvet1 suggested that serotonin is the major neuromodulator ofsleep,♦ Whereas Radulovacki presented data regarding the major role of adenosine insleep–wake regulation.♦ In 1975 Hobson and colleagues offered a new explanation proposing a reciprocalinteraction model of sleep–wake cycle control in an attempt to explain the sleep–wakecycle on a cellular level. This concept, based on the interaction of multiple and widelydistributed distinct groups of neurons, replaced the previous hypothesis of a single ‘sleepcenter’. A simplified version of the reciprocal interaction model may be explained asfollows: REM-ON cholinergic nuclei activate reticular formation neurons in a positivefeedback interaction to produce REM sleep. When REM sleep is ‘on’, this excites REM‘off’ neurons in the raphe and locus ceruleus systems. As the REM-OFF neurons becomeactive at the end of REM sleep, they terminate REM and the NREM period starts, whichinhibits REM-OFF cells, owing to self-inhibiting feedback, and then the cycle repeatsitself. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 72
  • Modern Review of Insomnia♦ One of the common features of the molecular and cellular theories is the idea of asingle form of NREM and a single form of REM. Alternative approaches to the singleNREM–REM model such as the sequential hypothesis of the sleep function weredescribed by Ambrozini and co-workers. They suggested that the functions of thesleeping brain depend on the nature of the previous waking experience.♦ Hernandez-Peon theory also considered NREM and REM as a unitary process.Other interesting theories (see Drucker and Merchant) attempting to unite several statesof human experiences suggested that sleep after feeding, stress, coitus, fatigue orinfection, etc. is not the same sleep, meaning it is not triggered by the same brainmechanisms. Therefore, NREM and REM sleep may have different initiating and controllingmechanisms, which may depend in part on the previous waking experience. There aremultiple excellent reviews describing in great detail a dozen sleep regulation theories.There is currently no consensus or generally accepted theory explaining sleep–wakecycle regulation, but all researchers agree on the fact that sleeping and waking areintimately united. You cannot understand sleep without understanding wakefulness andits mechanisms, and vice versa. Deep mechanisms of waking behavior are connected withmechanisms of sleep.Sleep Time When we sleep, and how much deep sleep and dreaming sleep we need varieswith age. Thus, seven to nine hours of sleep, which is adequate for most adults, wouldleave the average nine-year-old extremely sleepy during the daytime. Sleep requirementsfor different ages. As you can see, there are ranges for each age group. The amount of “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 73
  • Modern Review of Insomniasleep a woman needs is an individual characteristic just like her height. Each personneeds his or her own unique amount of sleep. The amount of sleep needed is that whichmakes you wide awake and alert. Research has also shown a link between sleep time andhealth. Table no.09 showing the Hours of Sleep according to Age Age A 24-hour period NappingBirth to 2 months 10 1⁄2 to 18 5 to 102 months to 12 months 14 to 15 2 1⁄2 to 512 months to 18 months 13 to 15 2 to 318 months to 3 years 12 to 14 1 1⁄2 to 2 1⁄23 years to 5 years 11 to 13 0 to 2 1⁄25 years to 12 years 9 to 11 **Teenage years 8 to 10 **Adult years 7 to 9 ** In general, the amount of sleep decreases with age. Babies spend an enormousamount of time sleeping (although it may not feel that way to their sleep-deprivedparents); for the first few months of life, most infants sleep at any time during the twenty-four-hour day. Finally and mercifully for the parents, they start to have long periods ofsleep mostly at night. Infants and toddlers nap. By the time children go to school, mostwill no longer nap. The amount of REM sleep also decreases with age. Newborns spend roughly halftheir sleep time in REM sleep. In adults the amount of REM experienced during sleepgoes down to between 20 to 25 percent. The amount of slow-wave sleep is also muchhigher in children; the time most people spend in slow-wave sleep decreases with aging.Some elderly people may have no slow-wave sleep. This is the sleep state during whichmost of the human growth hormone is secreted. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 74
  • Modern Review of Insomnia Repeatedly that people who consistently sleep too much (more than ten hours anight) or far too little (fewer than five hours a night) have a higher death rate. However,the key issue is not the length of sleep. Rather we believe that such abnormal amounts ofsleep are a symptom of a sleep or medical disorder that may cause or result in death.The Body Clock In our brain, a place called the suprachiasmatic nucleus (SCN) is a collection ofcells that have the ability to keep time and function as a pacemaker for our sleep-wakecycle which helps to know when it is time to go to sleep and to wake up. It turns out thatthis pacemaker controls not only the times when we are sleepy or alert, but it alsocontrols the function of many systems in the body. Most of the systems in the body have a pattern that varies over a twentyfour-hour period. This is true for the secretion of many hormones, blood pressure, heart rate,and other functions in the body. This natural, internal rhythm in function has been calledthe circadian rhythm. The word comes from circa meaning “about” and Diem meaning “day.” In otherwords, the cir - cadian rhythm changes the way many systems in the body work over thetwenty-four-hour day so that the function of the systems matches what the body needs.As a result, we usually don’t have to go to the bathroom and we don’t have hunger atnight. If you have traveled across time zones you know how discombobulated or out ofsync you can feel because of a disconnect between your own body clock and the timewhere you happen to be. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 75
  • Modern Review of InsomniaCircardian Rhythm Disorders:152 The DSM-IV establishes the following general diagnostic criteria and lists thefollowing four criteria for diagnosing circadian rhythm disorders:(1) A persistent or recurrent pattern of sleep disruption occurs which leads to insomniaand/or excessive daytime sleepiness secondary to a mismatch between the environmentand the individual’s circadian sleep - wake pattern.(2) The sleep - wake disturbance causes clinically significant distress or impairment insocial, occupational or other important areas of functioning.(3) The disturbance does not occur exclusively during the course of another sleepdisorder or mental disorder.(4) The disturbance is not due to the direct physiological effects of a drug of abuse,medication or other general medical condition.Advanced sleep phase syndrome Individuals are usually drowsy in the evening and awaken too early in themorning. This type sometimes is seen among the elderly, who may experience sufficientlifestyle impairment to warrant treatment. However, people with a strong ‘morning’tendency may Shift work and circadian rhythm disorders be called ‘larks’ and not allpresent with a phase advanced sleep–wake rhythm which interferes with daily life.Delayed sleep phase syndrome These individuals are more alert in the evening and night, tend to stay up muchlater than usual, and have difficulty awakening in the morning. This is often seen inadolescents and young adults, sometimes referred to as ‘owls’. If the desynchronize “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 76
  • Modern Review of Insomniabetween internal sleep - wake rhythms and external demands of daily living is severeenough, a diagnosis of phase delayed syndrome is made.Jet lag This is sleepiness and alertness experienced at an inappropriate time of dayrelative to local time, occurring after travel across more than one time zone.Shift work Insomnia may occur during the major sleep period and excessive sleepinessduring the major awake period. It is associated with night shift work or frequentlychanging shifts. A variety of factors affect the tolerability of shift work. These include thefit between an individual’s assignment and his best time of day, the direction of rotationand the speed of rotation. As society has become more industrialized, an increasing number of individualsare required to undertake shift work, estimates of the number of people thus engagedranging from 20 to 25% of the work force14. Many shift workers are chronically sleepdeprived and therefore suffer both sleep onset and maintenance insomnia. During themajor waking period, such individuals may suffer fatigue and reduced alertness. Poormood (irritable, depressed or anxious) may also result from sleep loss. Of perhapsgreatest importance is the fact that night shift workers are at increased risk of fallingasleep between about 3 and 5 a.m. In general, shift workers obtain about 2 h less sleep per day than non-shiftworkers, because if one is working nights, the physical and social environment makes itmore difficult to obtain good quality sleep during daylight hours. Under thesecircumstances, circadian factors exert greater influence on the ability to sleep than do the “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 77
  • Modern Review of Insomniahomeostatic factors (prior sleep loss). Adaptability to night shift work can be enhancedby the speed and direction of the rotation. Slower rotation used in the United Statespermit a worker to gradually adjust his circadian rhythms over a period of 2 to 4 weeks.Some authorities believe that the method reduces long-term damage to workers’ health.Many hidden costs occur when shift work is assigned without regard for a worker’shealth, safety or family concerns. Shift workers in particular appear more prone to digestive ailments, includingulcers, constipation and obesity1. This is probably due, in part, to poor eating habits,excess intake of caffeine and junk food and too little exercise. Improved health of shiftworkers may be obtained by modifying diet (e.g. switch to low fat, high fiber) andexercise routines. Of additional concern is the fact that most shift workers revert to theconventional sleep–wake times on days off but often have long periods of compensatorysleep. Thus, social and family obligations may be neglected during time off work.Shift work and circadian rhythm disordersDeterminants of Daytime Sleepiness: Not all daytime sleepiness is a result of inadequate amounts of total sleep time.The human sleep–wake cycle is regulated by two primary processes, process S andprocess C. Process S is the homeostatic drive to sleep. This drives increases duringwakefulness and decreases during sleep. If a sufficient amount of sleep is not achieved,either through decreased total sleep time (sleep quantity) or sleep fragmentation (sleepquality), our homeostatic drive for sleep increases and results in daytime sleepiness. Theamount of slow-wave sleep (stage 3 and 4) achieved is primarily linked to process S andthe duration of prior wakefulness. Process C is the circadian drive for sleep, which acts “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 78
  • Modern Review of Insomniaindependently of sleeping and waking. This drive increases sleepiness and alertnessduring different parts of the subjective day. Process C also controls our drive for REMsleep. REM sleep propensity is circadian phase dependent and not altered by anincreasing homeostatic drive for sleep. Other factors in addition to homeostatic andcircadian influences may affect an individual’s drive for sleep or wakefulness.InsomniaDefinition of Insomnia Insomnia is defined as an inability to obtain adequate sleep. This statement issufficiently broad to permit classification of essential commonalities, which arepersistence of the complaint (i.e. more than a transient poor night of sleep), and thesubjective element as noted by the word adequate. The latter also highlights the fact thatindividuals vary in their need for sleep. Insomnia is a complex problem, and it is now widely recognized that there can bemultiple causes for sleep disruption, including conditions such as sleep apnea, delayedsleep phase, periodic limb movements (PLMs), gastroesophageal reflux and drugreactions. However, clinicians are more likely to treat insomnia that is the result ofanxiety, depression, conditioned arousal, stress and sleep - wake cycle disturbances. Insomnia, difficulty in falling asleep and staying asleep, is a symptom and nota disease. When a person has a problematic symptom such as insomnia, it is up to thatperson to go to the doctor. It becomes the job of the doctor to determine the cause of thesymptom and then to treat the cause. The symptom of insomnia can be caused by manydifferent medical problems - a disturbance in sleep often indicates that there is something “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 79
  • Modern Review of Insomniaelse wrong in the body, and it might be serious. Disorders involving almost every singleorgan system can cause problems with sleep, which makes it all the more amazingthat doctors have only been asking about their patients’ sleep for the past few years. You name a chronic disease and it is probably associated with a sleep problem.Diabetes, kidney failure, arthritis, Parkinson’s disease, heart failure, and cancer are someof the commonly occurring medical conditions that can affect sleep and lead to sleepcomplaintsAffective Disorders: Sleep is much disrupted in depression and mania. Major depression usuallyproduces initial insomnia and sleep maintenance insomnia including early morningawakening. Patients most often complain of the inability to return to sleep as easily asusual. Individuals with atypical depressions and seasonal affective disorders more oftencomplain of hypersomnolence. A sleep laboratory recording may document specificabnormalities associated with depression. These include early onset of rapid eyemovement (REM) sleep, increased number of eye movements, reduction in stage 3 andstage 4 and poor sleep continuity. Several studies have now demonstrated that 1 year ofchronic untreated insomnia leads to depression in up to 50% of people. Adequatetreatment with antidepressants and psychotherapy will usually ameliorate the insomnia asthe depression improves. Most effective antidepressants significantly suppress REMsleep. Partial sleep deprivation, another effective treatment for depression, reduces REMby keeping the patient awake when REM sleep predominates (3–7 a.m.)Electroconvulsive therapy (ECT) also reduces REM time and normalizes REM– NREMcyclists. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 80
  • Modern Review of Insomnia In general, it has been shown that the amount of REM sleep suppression producedby an antidepressant correlates with its efficacy. Reduced REM latency is a consistentbiological marker of depression. Patients who have REM latency less than 60 minutesrespond dramatically to fluoxetine, while patients with REM latency longer than 65minutes respond the same as placebo subjects.Anxiety Disorders: Chronic anxiety usually produces sleep onset insomnia. Panic attacks can occur atthe onset of sleep or during stage 2 – stage 3 transition. Those occurring during REMsleep are called REM anxiety attacks. The differential diagnosis must include nocturnalseizures and night terrors. Anxiety disorders do not appear to produce the typicalabnormalities seen in major depression such as shortened REM latency. In fact, there areno consistent specific differences between the sleep parameters of patients with anxietydisorders.Alcohol and Drug Abuse: About 10–15% of patients with chronic insomnia abuse substances, especiallyalcohol and other sedatives. Although alcohol in low to moderate doses initially promotessleep, it disrupts and fragments sleep later in the night. Alcohol may exacerbatesleeprelated breathing disorders in some patients. A persistent sleep disturbance has beenemonstrated in chronically abstinent alcoholics. However, it is unwise to treat abstinentalcoholics with benzodiazepines or barbiturates since they are cross-tolerant with alcoholand patients can quickly become addicted to these drugs. People who are alcoholic oraddicted to sedative-hypnotics have severe insomnia during acute withdrawal.Hospitalization may be required for such patients for supervised gradual withdrawal. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 81
  • Modern Review of InsomniaInsomnia may persist for months following withdrawal. Sleep hygiene techniques mustbe taught and the underlying psychiatric syndromes should be treated.Sleep Talking: Sleep talking is quite common among adults and children. Most of the noises thatcome out are actually gibberish, although one might be able to make out individualwords. I have not heard of people blurting out secrets during sleep talking episodes. Thismight be considered an embarrassing condition, but it is not one that requires treatment.Sleep Terrors: This disorder, which can occur in children and in adults is also called “nightterrors.” Sufferers get out of bed abruptly, sometimes screaming with their eyes wideopen, and sometimes sweating. They appear to be terrified; sometimes they seem asthough they are about to commit a violent act. The person may let out a bloodcurdlingscream and display other bizarre behavior. Although it would seem that the person mightbe reacting to a dream. Sleep terrors are a form of sleepwalking and the treatment is the same. There is noneed to awaken people who are having these episodes; it is best to calmly walk them backto bed. The following morning, they have no recollection of the distress that they causedfor the other people in the house or of the actual event. Sleep terrors can be bizarre, butare not usually dangerous enough to require further treatment.Dreaming While Not Quite Asleep Some people, in the minutes before falling asleep and sometimes in the minutesdirectly after falling asleep, may sometimes have very frightening dreams that includesounds, visually rich images, and even sometimes sensations in various parts of the body. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 82
  • Modern Review of InsomniaThese dreams are called hypnagogic hallucinations. They are not normal. People don’tnormally dream unless they have been asleep for about ninety minutes. However, a sleep-deprived person may have hypnagogic hallucinations, and they are quite common inpeople who have narcolepsy.Teeth Grinding, or Bruxism: Bruxism is an increase in the activity of the jaw muscles while sleeping. Thiscondition occurs in children and adults and is equally common in females and males. Wedon’t know much about it except that it is more common in people under stress and canoccur as a reaction to certain drugs. The grinding can be extremely disruptive, and it canliterally wear down a person’s teeth. In some people, stress reduction alone is an effectivetreatment for bruxism. If the teeth are wearing down or if there is pain in the jaw, thisshould be checked out with a dentist, who may recommend a mouth guard to beworn at night.Head Banging and Body Rolling: One of the most unusual problems we see in the sleep clinic is a disorder inwhich a person repeatedly bangs her head against a mattress, a crib, or a wall. Somepeople rock their bodies the entire night and move around a great deal. As painful as it isto watch these patients, it turns out that this is not a serious problem. They are quitenormal in the daytime. Though it is scary for parents, most children who have thisdisorder grow out of it, although sometimes it continues into adulthood. The disorder isfound in about 8 percent of four-year-olds, and the number decreases even further witholder children. For reasons that are not known, this condition is four times more common “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 83
  • Modern Review of Insomniain males than in females. Some people with neurological problems might display similarmovements. This is a disorder that we do not normally treat unless the person is injuringhimself.Urinating in Bed: Enuresis, or urinating in bed, occurs because the mechanisms that normallykeep the sphincters of the urinary system working are not effective. This is a problem inchildren and the elderly. In children, the problem is caused by slow development ofbladder control. In the elderly, it is generally related to changes in anatomy brought on bythe aging process. Childhood enuresis can be very troubling for both the child and theparents. This problem is twice as common in boys. Children might develop a fear ofgoing to sleep because they are afraid that they will wet the bed. They become afraid tosleep over at a friend’s house. To make sure that there is no medical reason for thissymptom, children who have this problem should be evaluated by their pediatrician. There are alarm systems available that are triggered when the bed has beendampened. Such an alarm awakens the child, who eventually gains bladder control duringsleep. If this treatment is not effective, the doctor might recommend one of severalmedications. Desmopressin acetate (DDAVP) is a medication that imitates the effect of achemical produced by the pituitary gland that reduces the amount of urine. This drug,which is immediately effective, can be taken just before bedtime either in a nose spray orin pill form. A low dose of the antidepressant imipramine taken one to two hours beforebedtime can been used for many years to treat children who wet the bed. It is successfulin less than half the time. These treatments do not cure the problem, though. Nearly allchildren eventually gain bladder control. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 84
  • Modern Review of InsomniaSnoring: All of us think we know what snoring is and most of us have observed it firsthandor in people we know. Snoring is the loud noise people make while they are breathing induring sleep. Although the butt of jokes and countless cartoons, snoring usually signifiesthat the person’s upper breathing passage is obstructed. Snoring represents vibration intissues as the person is trying to suck air in. It can be so loud and disruptive that couplesmay start to sleep in different rooms or on different floors of the house.Treatments:Pharmacology of Sleep Hypnotics: 152 b Despite the recent progress in the use of non-benzodiazepines, physicians remainreluctant to prescribe drugs with sedative properties, i.e. hypnotics, because the risks areperceived to be too high. Many physicians have the impression that onerous side-effectare inevitable. In general, physicians should favor short-acting hypnotics over long-actingdrugs in primary insomnia when short-term use is anticipated. Chronic insomniaassociated with the anxiety disorders respond better to hypnotics with longer half-lives toreduce daytime anxiety. Some sleep hypnotics like Benzodiazepine hypnotics, Non – Benzodiazepine,Bright lights, Pharmacotherapy, Melatonin, Chronotherapy, Shift-work consultation /planning, etc. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 85
  • Drug Review DRUG REVIEWIntroduction: “The Drugs is as old as Disease”. Illness has been man’s heritage from the beginning of his existence, and thesearch for remedies to combat, is perhaps equally old. Now a days self administration ofa drug for non – medical reasons in quantities is common and frequencies which mayimpair an individual’s ability to function effectively and which results in social, physicalor emotional harm. Ayurveda – an eternal source of knowledge, has a multi angled textual materialincluding pharmaceutical knowledge. Drug is a part of quadruped of the treatment, whichhas the potential to bring about reversal in the process of pathogenesis and eradication ofthe signs and symptoms.The efforts of the physician who has the sound knowledge of pathology andpharmacology with due consideration of place, time and quantum, will never be fruitless.Further, a great deal of vitalistic approach has been given to the complete knowledge ofthe drug, right from procurement, identification to processing and application. Thecomprehensive knowledge of the drug is very important to physician because withoutknowledge of drug the patient cannot be treated properly.Drugs used:For Group – A Murchitha Tila Taila & Murchitha Gritha “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 86
  • Drug ReviewTila Taila153 Acharya charaka mentioned that Tilataila is best among the taila vargas. The word“Taila” is derived from Sanskrit - “Tilodbhavam” means, one which is derived from Tila-sesamum. But in general, ‘Taila’ is considered for all oils. It is vata shamaka From therapeutic point of view, when taila is subjected (samskara) with otherdugs it takes the property of that drug. Vagbhata explains the importance of Tilataila as, itdoes Brhmana Karya for Krisha persons and does Karshana for Sthula persons.Composition: Palmitic acid (9.1%), stearic acid (4.3%), arachidic acid (0.8%), oleic acid(45.4%), linoleic acid (40.4%). Drugs used for taila murchana are given along with the properties of each drug asManjistha, Haritaki, Amalaki, Vibhitaki, Mustha, Haridra, Lodra, Vatankura, Hrivera,Nalika, Ketakipushpa.Importance of murchana of Tila taila:154 By doing murchana the Amadosha in the taila is removed, also durgandhata &ugrata are removed. After doing Murchana Samskara, taila gets good smell and colour.By doing Taila paka and Murchana the veerya of the Sneha is enhanced.Mahisha Ghrita: (Sneha):155 a, b, cSanskrit name : SarpiEnglish name : GheeGana : Madhura Skanda (Cha.)Guna : Snigha, Guru “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 87
  • Drug ReviewVirya : SheetaVipaka : MadhuraDosha Karma : Tridosha ShamakaSource : Animal fat, Jangama SnehaAction : Rasayana, Vajikarana, Rasavardhaka, Svarya, Varnya, beneficial for Bala,Vriddha, Abala (Stri), Kshata and Kshina, increases Oja, Medha, Smriti, Agni andIndriyabala.Drugs used for Ghrita murchana are given below, along with the properties of each drug Table no.10 showing the Drugs used for Ghrita murchanaNo Drugs Rasa Guna Virya Vipaka Doshaghnata Parts used Laghu, Ushna Madhura Tridoshagna Phala, twak1. Pathya Except lavana ruksha, ushna Guru, Sheeta Madhura Tridoshagna Phala2. Dhatri Except lavana snigdha, sara3. Vibhitaki Kashaya, tikta Laghu, Ushna Madhura Kapha and Phala ruksha, Pitta shamana ushna4. Musta Katu, tikta, Laghu, Sheeta Katu Kapha and Kanda kashaya Ruksha Pitta shamana5. Rajani Tikta, Ruksha, Ushna Katu Tridoshagna Moola Katu Laghu6. Matulunga Amla Tikshna Anushna Amla Kaphavata Phala Shamaka Ghrita possesses a Yogavahi property. Ghrita is one among Mahasneha.According to Vagbhata Mahisha Ghrita is having the property of Nidrajanaka and alsobest Rasayana effect. It improves Smriti, Medha, Buddhi, Varna, Swara, Saukumaryataand Ojas in the body; it strengthens sensory organs and softens the body. Ghrita isrecommended as main pathya in Vatavyadhis. In Vata disorders Sneha instantaneouslyprovides nourishment to Ksheena Dhatus, it promotes Bala, Agni and longevity of life. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 88
  • Drug ReviewChemical Contents: Tryglycerides, Diglycerides, Monoglycerides, Keto acid glyceride,Glycerylesters, free fatty acids, phospholipids sterols, Vitamin A, D, E & K. Vitamin - A & K are antioxidant helpful in preventing oxidative injury to thebody. No other edible oil contains vitamin-A except fish oil. Vitamin A keeps epithelialtissue of the body intact, keeps the outer lining of the eyeball moist and preventsblindness. Ghrita also contains 4-5% Linoleic acid & essential fatty acid, which promotesproper growth of human body. Ghrita resists spoilage by microorganisms or chemicalaction. Digestion, absorption and delivery to a target organ are facilitated by Ghrita,which is crucial in obtaining the maximum benefit from any formulation. Since activeingredients one mixed with ghrita, they are easily digested and absorbed - Lipophilicaction of ghrita facilitates transportation to a target organ and final delivery inside thecell, because cell membrane also contains Lipid. The modern Lipophilic nature can becompared with the "yogavahi" Guna of Ghrita according to Ayurveda. This Lipophilicnature of ghrita facilitates entry of the formulation in to the cell and its delivery to themitochondria, microsomes and nuclear membrane.For Group – B Murchitha Tila Taila, Yastimadhu and Mahisha ksheera “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 89
  • Drug ReviewMurchitha Tila Taila: Already explained in the above reviewYastimadhu: 156 a, bLatin name : Glucyrrhiza glabraFamily : Leguminoseae (Papillionate)Vernacular names:-English : Sweet wood, LiquoriceHindi : Mithi Lakadi-MuletheeSynonyms: Madhuka, Klitaka, Madhulika, JalajaGana: According to Charaka: Rasayan, Jivaniya, Varnya Sandhaniya, Kandughna,Kanthya Dahaprashamana, Angamarda Prashamana, Shonita Sthapana, Mutravirajaniya,Shnehopaga, Vamanopaga, Asthapanopaga Chardinigrahana According to Sushrutha: Stanyajanan, Kakalyadi, Sarivadi, AnjanadiPart used : Moola (root) Table no.11 showing the Properties of YastimadhuDrug Rasa Guna Virya Vipaka Prabhava DoshaghnataYastimadhu Madhura Guru Sheeta Madhura Kanthya, Vata Pitta Tikta Snigdha Varnya Shamak Sheeta “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 90
  • Drug Review Table no.12 Showing the Therapeutic Actions of YastimadhuDrug In term of Ayurveda In term of Pharmacology General Specific General SpecificYastimadhu Rasayana, balya, Daurbalya, Tonic, Restorative, Gastric ulcer, Vrishya, Swarabheda, anti ulcerative, General Kanthya, Koos, Vibandha, Demulcent, Debility, Nadibalya, Smritihrasa, Refrigerant, Seminal Medhya, Mridu Vrana, Estrogenic, Anti- Weakness rechana Mutral, Mutrakriccha, inflammatory Varnya, Jivaniya, Tvakvikar, Rakta Sandhaniya, pitta, Daha, Jirna Chakshushya, Jvara, Trishna, Dahashamaka, Glani KeshyaMahisha ksheera: 157 a, b, c, d, e According to Vagbhata directly indicated the mahisha kseera in Nidranasha.Acharya Charaka has mentioned regarding milk that it has Madhura, Snigdha, Shita etc.properties and it can be used for various Panchakarma’s. Moreover, milk has sameproperties like Oja, therefore prompts the Oja also.Table no.13 showing the ksheera having the properties as follows, Rasa Guna Virya Vipaka Doshaghnata Guru, Pichhila,Mahisha Madhura Bahala, Sheeta Madhura Vata PittaKsheera Shlakshana, Shamak Snigdha, Sheeta, Manda, Mridu, PrasannaComposition of Ksheera:58% more calcium than cow’s milk,40% more protein than cow’s milk “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 91
  • Drug Review It is significantly lower in cholesterol and higher in calcium than cows, sheep’s orgoats milks. And unlike the array of industrially produced soya and other cereal milks itis totally free of additives and chemical formulations. Table no.14 Showing the Milk Composition Analysis Milk Composition Analysis Constituents Buffalo Protein 4.5 grm Fat 8.0 grm Carbohydrate 4.9 grm Energy 110 K cal 463 K J Sugars (Lactose) 4.9 grm Fatty Acids- 4.2 grm Saturated 1.7 grm Monounsaturated 0.2 grm Polyunsaturated Cholesterol 8 mg Calcium 195 iu In addition to the significant cholesterol and calcium benefits Buffalo Milk is alsoa rich source of iron, phosphorus, vitamin A and of course protein.Buffalo Milk also contains high levels of the natural antioxidant tocopherol. Peroxidateactivity is normally 2-4 times that of cow’s milk. An unfortunate sign of the times is thegrowing number of people who suffer from cow’s milk allergy. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 92
  • Materials MATERIALS USED FOR THE STUDYFor Sarpi Nasya Murchitha tila taila & Murchitha GrithaPreparation of Tila taila murchana: 158 For the taila Murchana 1/16 parts of Manjistha, Haritaki Vibhitaki Amalaki Mustha 1/64 parts of Haridra Lodra Vatankura Hrivera Nalika Ketakipushpa 1 part of Tila taila, and 4 parts of jala was taken and reduced for taila avasesha.Preparation of Ghrita murchana: 159 One prastha of Mahisha Sarpi Kalka of drugs - Pathya DhatriEach taken one pala of Vibhitaki Musta RajaniOne pala of Matulunga swarasa and four prastha of Jala.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 93
  • Materials Prepared by heating the Sarpi on mandagni till it stops foaming (i.e., till all thewater content evaporates) and attaining the Ghrita siddha lakshana. Sarpi was allowedto cool down and filtered. This will be free from Amadosa and becomes more potent.Materials or Tools for therapeutic intervention: To administer Nasya - Nasya peeta or Nasya asana, Droni or Pathy, SthanikaAbhyanga aushada (murchitha tila taila), Nasya Aushadha (Murchitha ghrita), Cottonor Dropper for instillation, Cotton Swab, Kidney tray, and Cloth was used.For Nadi Sweda - 6 litres of pressure cooker, 2 meters rubber tube and gas stove.For Yastiksheera Dhara Murchitha Tila taila Yastimadhu & Mahisha KsheeraPreparation of Yastiksheera: 161Prepared with One part of Yastimadhu drug, Eight parts of Mahisha ksheera, Thirty two parts of Water, i.e. (1:8:32).Boiled in moderate heat and reduced to the quantity equivalent of milk i.e. (1/8th).After cooling the yastiksheera is used for the Dharakarma.Materials or tools for therapeutic intervention: Dhara table – specially prepared table having round and concave extraprojection with central hole to keep the head over it and also to collect the pouringmedicine, for rerouting,“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 94
  • Materials & Methods Dhara patra - It is a shallow, about 5 or 6 inches in depth, wide-mouthed andcurved bottomed vessel of the capacity of not less than 2 prasthas, which is having holein the centre of the vessel. Small vessel with water and Gas stove is used for heating yastiksheera indirectly.Murchita tila taila and Murchita Gritha: A total 10 litre of Murchitha tila taila and 2 litre of Murchitha mahisha - ghritawas prepared in the department of Rasashastra and Bhaishajya kalpana, D.G.M.A.M.C.and H. Gadag. METHODSClinical study:Research Approach: In the present study, the main objective is “The Effect of Yasti Ksheera Dharaand Sarpi Nasya in Nidranasha” - A Comparative Clinical Study”. The efficacy wasdetermined by finding out the difference between the baseline data of the parameters tothe after pariharakala data.Study Design: The study design set for the present study is ‘Prospective clinical trial (AComparative Clinical Observational Study)’.Reasons for selection of the study design: The results and conclusions of a clinical trial depend on the study design. The aimof this study was to find out the “The Effect of Yasti Ksheera Dhara and Sarpi Nasya inNidranasha” - A Comparative Clinical Study”. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 95
  • Materials & MethodsSource of Data: Patient suffering from Nidranasha were selected from O.P.D and I.P.D. ofD.G.M.A.M.C & H., Gadag after following the Inclusion and Exclusion criteria.Sample Size & Group:A total number of 30 Patients suffering from Nidranasha were selected and assigned intoa two group (from OPD & IPD). Group A: 15 patients for Nasya theraphy with Sarpi. Group B: 15 patients for Dhara procedure with YastiksheeraDiagnostic criteria: The clinical features of Nidranasha or Insomnia as mentioned in texts.Inclusion Criteria: 1. Patients complaining of reduction in sleep time, 2. Difficulty in Initiating Sleep, 3. Wakefulness during Normal Sleep, 4. Any of the above (or) all of the above will be included.Exclusion Criteria: 1. Nidranasha due to other conditions like Madatyaya, 2. Nidranasha due to Abhigata, 3. Pregnant Woman, 4. Lactating Mothers, 5. Associated with any other systemic and metabolic disorder, 6. Severe Psychic disorder 7. Kaphaja vikaras(f) Posology: Nasyakarma: 8 drops in each nostril will be used. Dharakarma: Total 1 litre to 1.2 litre of yasti ksheera is used. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 96
  • Materials & Methods(g) Study Duration: Group A: Nasya karma for 7days, Follow-Up Period: for 15days. Group B: Dhara karma for 7days, Follow-Up Period: for 15days.(h) Total Study Duration: Twenty two days for both Groups A & B respectively.Procedures:Nasyakarma:Purvakarma: All the patients were asked to be in the hospital with in 4pm to 6pm. Each patientwas made to lie down on the Table or Droni or Pathy. Each patient was given Sthanikamukha abhyanga with Murchitha Tila taila on head (lalata), face (kapaala), nose andneck, followed with Mrudu Nadi swedana. While doing nadi sweda the eyes are coveredwith wet cotton swab for the protection from the swedana. The swedana is adopted toproduce vilayana of doshas.Pradhanakarma: The method of administration of Nasyakarma was strictly followed as told by theAcharyas. The patient who was undergone purvakarma is made to lie down on thedroni/table and the pillow is kept under the neck in order to facilitate easy administrationof nasya through the nose. The head and legs are in extended position. The Murchitha ghrita is made luke warm indirectly, by keeping on the warmwater. With the left hand thumb finger the tip of the nose is wide opened and left side of “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 97
  • Materials & Methodsthe nose is closed with index finger and the ghrita is administered in right nostril, viseversa. Murchitha ghrita was administered to all patients using plastic dropper. A quantityof 8 bindus of Murchitha Ghrita was administered to each Nostril.Paschatkarma: The patient was made to inhale the ghrita through each nostril i.e., patientwas asked to take slow deep breath through nose and exhale through mouth, till the ghritacomes to the throat. The pani and pada is rubbed vigorously for short time. Slightmassage was done over urdwajatrugata pradesha after Nasya pranidhana. The head islowered suitably, because the Nasya will move to Shringataka marma and thereby tomastulunga, which causes complication. The patient was made to spit the medicament,which comes through the throat, to the kidney tray which is kept near to the patient. Patient was made to spit, till feels comfort. Patient was made to relax for fiveminutes160. Then patient was made kavalagraha with luke warm salt water and followedwith Dhumapana was administered. Purpose is to make the kapha to dissolve (vilayana ofkapha dosha). The patient is advised to take complete rest The same procedure was repeated for 7days. The time of administration andcomplication were noticed if any. The patient was asked to follow a pariharakala of 14days and was asked to report on 22nd day counting from the day the treatment schedulestarted, for follow up and observation. And on 22nd day is taken for assessing theparameters. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 98
  • Materials & MethodsDharakarma:Purvakarma: All the patients were asked to be in the hospital with in 4pm to 6pm.Each patientwas given Sthanika shiro abhyanga with Murchitha Tila taila in sitting posture. The thickthread of gauze and it is tied on forehead above the eyebrows. Patient made to lie down on the Dhara table in comfort position. Before doingDharakarma the eyes are covered with wet cotton swab, so that liquid may not enter intothe eyes. The height of flow of the Dhara patra was adjusted about four finger space i.e.,about 3 inches above the forehead, if it is too high or too low leads to complications likeheadache, burning sensation on eyes, etc.Pradhanakarma: The Yastiksheera was prepared daily around 1000ml to 1200ml and used for theDhara purpose. The treatment room was noiseless. The cooled yastiksheera was poured inthe Dhara patra and be poured continuously and slowly on the upper part of the foreheadof the patient i.e., above the tied thread like gauze. A mild oscillation was given, becauseto maintain the flow to all over the forehead. The vessel is kept refilled with the drippings collected from the sink in thewooden basin in which the patient lies down. The collected ksheera was made Sukoshnaindirectly and was poured continuously. The thickness of the stream and the flow of thestream were maintained till completion of treatment. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 99
  • Materials & Methods The treatment schedule was 1st day 30min, 2nd day 35min, 3rd day 40min, 4th day 45min, 5th day 40min, 6th day 35min and 7th day 30min. is maintained to all patients.Paschakarma: After completion of the Dhara, the cotton swab and the tied thread are removedslowly. Then patient was made to wipe the head with the towel and advised to take Lukewarm water bath after 30 min. After bath patient was made to wipe the head withoutdelay. It is done carefully so that no moisture was retained. After wiping, rubbed themedicated powder like Rasnadi choorna on the murdha to prevent the occurrence of Cold,fever, etc. Then patient is advised not to exposed to the sun or wind directly and cotton isgiven to keep in both the ears, to prevent from any other complications (i.e., from anycold breeze). The same procedure was repeated for 7days162. The time of administration and thetime of completion, along with complication were noticed if any. The patient was askedto follow a pariharakala of 14 days and was asked to report on 22nd day counting from theday the treatment schedule started, for follow up and observation. And on 22nd day istaken for assessing the parameters.Assessment of Results:163 Subjective and Objective Parameters Pre Medication to Post MedicationData is used for Clinical Assessment of Results are as follows. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 100
  • Materials & Methods(a) Subjective Parameters: • Angamarda • Jrumbha • Shirogaurava • Sleeplessness • Difficulty in initiation sleep • Sleep Quality • Performance of daily activities • Vitality after morning awakening (b) Objective Parameters: • Total Sleep Time (hrs) • Wakefulness during sleep (in number)Examination for Nidranasha:Sleep History Questionnaire: Patients are diagnosed according to diagnostic criteria given for insomnia inDSM – IV. Patients may be asked to complete a questionnaire to determine Sleep - wakeschedule The Sleep - wake schedule disturbance involves the displacement of sleep from itsdesired circadian period. Patients commonly cannot sleep when they wish to sleep,although they are able to sleep at other times. Correspondingly, they cannot be fullyawake when they want to be fully awake, but they are able to be awake at other times. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 101
  • Materials & Methods The disturbance does not precisely produce Insomnia, although the initialcomplaint is often insomnia or somnolence, the inabilities to sleep and be awake areelicited only on careful questioning. Sleep - wake pattern disturbance can be considered amisalignment between sleep and wake behaviors. This Sleep history Questioner is helpfulin diagnosing a patient’s sleep disorder, which is given along with Grading. Table No.15 showing the Sleep history QuestionerS.No. Questions Grading1 Do you nap during the day?2 Do you have trouble concentrating during the day?3 Do you trouble falling asleep when you first go to bed? Grade 0 – 01 to 20%4 Do you awaken during the night? Grade 1 – 21 to 40%5 Do you awaken more than once? Grade 2 – 41 to 60%6 Do you awaken too early in the morning? Grade 3 – 61 to 80%7 Are you regularly awakened at night by pain or the need to use the bathroom? Grade 4 – 81 to 100%8 Does your job require shift changes?9 Do you drink caffeinated beverages (coffee, tea, or soft drinks)?10 Have you ever suffered from depression, anxiety or similar problem?Calculation:Total number of counted is divided by 10 *100 for each patientMethods of Assessment of Clinical Response: Assessment of Clinical Response was based on DSM – IV criteria Subjectiveparameters and objective parameters were made out to assess the Clinical response. Aspecial proforma was prepared with gradation of symptoms and scoring was doneaccording to severity. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 102
  • Materials & MethodsSubjective parameters:Angamarda: Body ache is common symptom of the Anidra patients as they aresubjected for increased muscle tone with enhanced sympathetic activity.It may or maynot present in all patients. Thus the Angamarda is observed in the study with the gradesas follows.Shirogaurava: is also common symptom of the Anidra, patient gets severe unilateralheadache with heaviness that often appears during sleep and also is more frequent inevery day. Thus the grades are given below for the study.Jrumba: Yawning is the expression of the sleep and lack of sleep, seen in Anidra. It mayor may not be present in all patients. The intensity of the yawning is necessary to measureto evaluate the sleep patterns. Thus the following grades are inducted.AngamardaShirogaurava Grade 0 – Absent Grade 1 - PresentJrumbhaSleeplessness: Sleeplessness can have a serious impact upon one’s ability to perform at work andmaintain healthy social relationships, and it can be the source of, or contribute to, avariety of psychological disturbances, including major mood.Almost every system in thebody undergoes changes during sleep. The Patho - psychological changes associated withmany medical disorders causes changes in both sleeping and waking states. Thus thegrades are given below for the study of Sleeplessness. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 103
  • Materials & MethodsNo complaint Grade 0Patient gets sleep at night (or) Grade 1Awakens early in the morningDisturbed Sleep during night Grade 2Gets Sleep after taking sedatives Grade 3Doesn’t get Sleep at all Grade 4Difficulty in initiating sleep Difficulty falling asleep and staying asleep, although they are usually consideredseparately, but belong to the same group of symptoms. Difficulty in initiating sleep is agradual process which changes from person to person and time to time. For properassessment of the sleep, the following grading are given below,Sleep immediately after go to bed Grade 0Less than One hour late sleep (or) Grade 1One hour late Sleep after go to bedTwo hours late sleep after go to bed Grade 2More than Two hours late after go to bed Grade 3Sleep Quality Variation of physiological functions in normal sleep may be exaggerated in casesof sleep disorders to a degree that sets a condition for development of emotional,behavior and cognitive pathology, such as depression, confusion, or impulsive behavior.Thus the following grades are inducted for the study of Sleep quality.Enjoyable sleep Grade 0Anxious or agitated before and during sleep Grade 1Feeling unfreshed and unrest after sleep Grade 2Sleep experience negative and not enjoyable Grade 3 “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 104
  • Materials & MethodsPerformance of daily activities The behavior of an active and alert person demands fast, precise, highlyspecialized and differentiated reactions with concentrated attention and a variety ofmodulations. Thus the performance of daily activities are graded as below,No Disturbance Grade 0Slightly Disturbed Grade 1Moderately Disturbed Grade 2Highly Disturbed Grade 3Vitality after morning awakening Especially in adults - decreased sleep duration caused by the increased sleeplatency, awakenings during the night sleep and early morning awakenings, are changesfrom person to person. The vitality after morning awakening thus graded as below,Feeling Freshness Grade 0Sleepy or fatigued Grade 1Poor concentration Grade 2Irritating mind Grade 3Objective Parameter:Total Sleep Time (hrs) When we sleep, and how much deep sleep and dreaming sleep we need varieswith age. Each person needs his or her own unique amount of sleep. The amount of sleepneeded is that which makes wide awake and alert. Thus the grades are given below forthe study.Normal sleep (8hrs) Grade 0Adequate sleep (6 - 8hrs) Grade 1Inadequate sleep (4 - 6hrs) Grade 2Sleep 4hrs (or) less than 4hrs Grade 3No sleep at night Grade 4 “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 105
  • Materials & MethodsWakefulness during sleep (In number) The roots of adaptive human behavior are based on productive wakefulness.Productive wakefulness (meaning sustained alertness and focused attention) is anintrinsic part of the sleep - wake cycle. Some changes in the sleep-wake cycle arenonspecific. Thus the following grades are inducted below.No wakefulness Grade 0One to two times wakefulness Grade 13 to 4 times wakefulness Grade 2More than 4 times wakefulness Grade 3Overall Assessment of Clinical Response: Good Response : >75% improvement in clinical parameters Moderate Response : 50-75% improvement in clinical parameters Poor Response : up to 50% improvement in clinical parameters No Response : 0 % or No improvement in clinical parameters “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 106
  • Photo“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 107
  • Observation & Results OBSERVATION & RESULTS The observation of the patients and the disease was done by providing thequestionnaire to those patients who can fill the case sheet and from those who can’tfill; the information was collected by translating the questions in the local language.The case sheet is attached in the appendix. All the patients were examined thoroughlybefore their inclusion in the study. The observation was done by considering thesubjective and objective parameters strictly. The observations were done in the following heading and are depicted in form andgraphs are used where ever necessary; 1. Observation of demographic data. 2. Observation of the patient. 3. Observation of the disease. 4. Observation of the data related to the response of the patient. 5. Observation of the statistical out comes of the study.Observation of demographic data: Table16 showing the distribution of patient’s age group Age No of patients and percentage group Group A Group B Total No. of % No. of % No. of patients % patients patients 20 – 35 9 60.00 9 60.00 18 60.00 36 – 50 6 40.00 4 26.66 10 33.33 51 - 65 0 00.00 2 13.33 2 6.66Group A: Out of fifteen patients 09(60%) were belonging to 20 - 35 age group,06(40%) was from 36 - 50 age group, No patients in 51 - 65 age group.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 108
  • Observation & ResultsGroup B: Out of fifteen patients 09(60%) fell under 20 - 35 age group, 04(26.66%)were from 36 - 50 age group, 02(13.33%) were from 51-60 age group and 07(46.66%) were from 61-70 age group.Overall: Out of thirty patients 18 (60%) were from 20 - 35 age group, 10 (33.33%)from 36 - 50 age group, 02 (6.66%) from 51-60 group and 13 (43.33%) were from 61-70 age group.Fig No 02 showing the distribution of patient’s age group: 18 18 16 14 12 10 9 9 10 20-35 8 6 36-50 6 4 4 50-65 2 2 2 0 0 Group A Group B Total Table no. 17 showing the distribution of patients according to sex Sex Group A no. and Group B no. and Group A and B % % no. and % Male 09 (60.00%) 11 (73.33%) 20 (66.66%) Female 06 (40.00%) 04 (26.66%) 10 (33.33%)Group A: Among 15 numbers of patients 09 (60.00%) were males and 06 (40.00%)were females.Group B: Among 15 numbers of patients 11 (73.33%) were males and 04 (26.66%)were females.Overall: Distribution of sex was; male were 20 (66.66%) and females were 10(33.33%) in 30 patients.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 109
  • Observation & ResultsFig No 03: showing the distribution of patient’s sex group: 20 20 18 16 14 12 11 10 9 10 Male 8 6 Female 6 4 4 2 0 Group A Group B Total Table no. 18 showing the distribution of patients by Occupation Occupation Group A no. and Group B no. and Group A and B % % no. and % Student 03 (20.00%) 04 (26.66%) 07 (23.33%) Labor 04 (26.66%) 05 (33.33%) 09 (30.00%) Executive 02 (13.33%) 01 (6.66%) 03 (10.00 %) Sedentary 06 (40.00%) 05 (33.33%) 11 (36.66%)Group A: Out of fifteen patients 3 (20.00%) were students, 04 (26.66%) were labors,02 (13.33%) was executive and 06 (40.00%) were sedentary by occupation.Group B: Out of fifteen patients 04 (26.66%) were students, 05 (33.33%) were labors,01 (6.66%) was executive and 05 (33.33%) was of sedentary by occupation.Overall: Out of thirty patients 07 (23.33%) were students, 09 (30.00%) were labors,03 (10.00 %) was executive and 11 (36.66%) were belonging to sedentary category. Figure 04 showing distribution of patients by occupation 12 11 10 9 Students 8 7 labors 6 6 Executives 5 5 Sedentary 4 4 4 3 3 2 2 1 0 Group A Group B Total“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 110
  • Observation & Results Table 19 showing distribution of patients by Economical statusEconomical status Group A no. and Group B no. and Group A and B % % no. and % Poor 05 (33.33%) 05 (33.33%) 10 (33.33%) Middle class 06 (40.00%) 05 (33.33%) 11 (36.66%) Higher class 04 (26.66%) 05 (33.33%) 09 (30.00%)Group A: Out of fifteen patients 05 (33.33%) were belonging to poor status, 06(40.00%) were of middle class, 4 (26.66%) were of Higher class.Group B: Out of fifteen patients 05 (33.33%) were belonging to poor status, 05(33.33%) were of middle class, 05 (33.33%) were of Higher class.Overall: Out of thirty patients 10 (33.33%) were belonging to poor status, 11(36.66%) were of middle class, 09 (30.00%) were of Higher class.Figure 05 showing distribution of patients by Economical status 12 11 10 10 9 8 6 Poor 6 5 5 5 5 Middle class 4 4 Higher class 2 0 Gr o up A Gr o up B T o t alTable No. 20. Showing distribution of patients by Marital Status Married Un Married Group A 10 (66.66%) 05 (33.33%) Group B 09 (60.00%) 06 (40.00%) Overall 19 (63.33%) 11 (36.66%)Group A: Out of fifteen, 10 (66.66%) were married and 05 (33.33%) were Unmarried.Group B: Out of fifteen, 09 (60.00%) were married and 06 (40.00%) were Unmarried.Overall: Out of thirty patients, 19 (63.33%) were married and 11 (36.66%) wereUnmarried“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 111
  • Observation & Results Figure 06 showing distribution of patients by Marital Status 20 19 18 16 14 12 11 10 Married 10 9 8 Un Married 6 6 5 4 2 0 Group A Group B Total Table 21 showing distribution of patients by Pradhana VedanaPradhana Vedana Group A no. and Group B no. and Group A and B % % no. and %Reduction in sleep 11 (73.33%) 09 (60.00%) 20 (66.66%) time Difficulty in 10 (66.66%) 12 (80.00%) 22 (73.33%) initiating sleepWakefulness during 12 (80.00%) 12 (80.00%) 24 (80.00%) sleepGroup A: Out of fifteen patients 11 (73.33%) were belonging to Reduction in sleeptime, 10 (66.66%) were of Difficulty in initiating sleep, 12 (80.00%) were ofWakefulness during sleep.Group B: Out of fifteen patients 09 (60.00%) were belonging to Reduction in sleeptime, 12 (80.00%) were of Difficulty in initiating sleep, 12 (80.00%) were ofWakefulness during sleep.Overall: Out of thirty patients 20 (66.66%) were belonging to Reduction in sleep time,22 (73.33%) were of Difficulty in initiating sleep, 24 (80.00%) were of Wakefulnessduring sleep.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 112
  • Observation & Results Figure 07 showing distribution of patients by Pradhana Vedana 25 24 22 20 20 Reduction in 15 sleep time 12 12 12 Difficulty in 11 10 10 9 initiating sleep Wakefulness during sleep 5 0 G r o up A G r o up B T o t al Table 22. Showing distribution of patients by Anubanda vedanaAnubanda vedana Group A no. and Group B no. and Group A and B % % no. and % Jrumbha 07 (46.66%) 06 (40.00%) 11 (36.66%) Shirogaurava 13 (86.66%) 12 (80.00%) 25 (83.33%) Angamarda 11 (73.33%) 09 (60.00%) 20 (66.66%) Bhrama 07 (46.66%) 04 (26.66%) 11 (36.66%) Apakti 08 (53.33%) 07 (46.66%) 15 (50.00%) Shirashoola 10 (66.66%) 08 (53.33%) 18 (60.00%)Group A: Out of fifteen patients 07 (46.66%) were had Jrumbha, 13 (86.66%) werehad Shirogaurava, 11 (73.33%) were had Angamarda, 07 (46.66%) were had Bhrama,08 (53.33%) were had Apakti and 10 (66.66%) were had Shirashoola.Group B: Out of fifteen patients 06 (40.00%) were had Jrumbha, 12 (80.00%) werehad Shirogaurava, 09 (60.00%) were had Angamarda, 04 (26.66%) were had Bhrama,07 (46.66%) were had Apakti and 08 (53.33%) were had Shirashoola.Overall: Out of thirty patients 11 (36.66%) were had Jrumbha, 25 (83.33%) were hadShirogaurava, 20 (66.66%) were had Angamarda, 11 (36.66%) were had Bhrama, 15(50.00%) were had Apakti and 18 (60.00%) were had Shirashoola.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 113
  • Observation & Results Figure 08 showing distribution of patients by Anubanda vedana 25 25 20 20 18 Jrumbha 15 13 15 Shirogaurava 12 Angamarda 11 11 11 10 10 9 Bhrama 8 8 7 7 6 7 Apakti 5 4 Shirashoola 0 Group A Group B Total Table 23. Showing distribution of patients by Mode of Onset Mode of Onset Group A no. and Group B no. and Group A and B % % no. and % Chronic 01 (6.66%) 02 (13.33%) 03 (10.00 %) Acute 14 (93.33%) 13 (86.66%) 27 (90.00%)Group A: Out of fifteen patients 01 (6.66%) were had Chronic onset and 14 (93.33%)were had Acute onsetGroup B: Out of fifteen patients 02 (13.33%) were had Chronic onset and 13(86.66%) were had Acute onsetOverall: Out of thirty patients 03 (10.00 %) were had Chronic onset and 27 (90.00%)were had Acute onset Figure 09 showing distribution of patients by Mode of Onset 30 27 25 20 15 14 13 Chronic 10 Acute 5 3 2 1 0 Group A Group B Total“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 114
  • Observation & Results Table 24. Showing distribution of patients by Kula vruttanta Kula vruttanta Group A no. and Group B no. and Group A and B % % no. and % Joint Family 07 (46.66%) 08 (53.33%) 15 (50.00%) Nuclear Family 07 (46.66%) 07 (46.66%) 14 (46.66%)Staying away from 04 (26.66%) 05 (33.33%) 09 (30.00%) Home Physicaldisturbances in the 04 (26.66%) 08 (53.33%) 12 (40.00%) family Psychologicaldisturbances in the 06 (40.00%) 09 (60.00%) 15 (50.00%) familyGroup A: Out of fifteen patients 07 (46.66%) were had Joint Family, 07 (46.66%)were had Nuclear Family, 04 (26.66%) were had Staying away from Home, 04(26.66%) were had Physical disturbances in the family, and 06 (40.00%) were hadPsychological disturbances in the family.Group B: Out of fifteen patients 08 (53.33%) were had Joint Family, 07 (46.66%)were had Nuclear Family, 05 (33.33%) were had Staying away from Home, 08(53.33%) were had Physical disturbances in the family, and 09 (60.00%)were hadPsychological disturbances in the family.Overall: Out of thirty patients 15 (50.00%) were had Joint Family, 14 (46.66%) werehad Nuclear Family, 09 (30.00%) were had Staying away from Home, 12 (40.00%)were had Physical disturbances in the family, and 15 (50.00%) were hadPsychological disturbances in the family. Figure 10 showing distribution of patients by Kula vruttanta 16 15 14 15 14 Jo int Family 12 12 Nuclear Family 10 9 9 Staying away fro m ho me 8 7 8 7 8 7 6 P hysical disturbances in the 6 5 family 4 4 4 P sycho lo gical disturbances in the family 2 0 Gr o up A G r o up B T o t al“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 115
  • Observation & ResultsTable 25 Showing distribution of patients by Occupational History Occupational Group A no. and Group B no. and Group A and B History % % no. and % Physical stress 08 (53.33%) 08 (53.33%) 16 (53.33%)Psychological stress 06 (40.00%) 09 (60.00%) 15 (50.00%) Social stress 08 (53.33%) 07 (46.66%) 15 (50.00%) Economical stress 07 (46.66%) 06 (40.00%) 13 (43.33%)Group A: Out of fifteen patients 08 (53.33%) were Physical stress, 06 (40.00%) werePsychological stress, 08 (53.33%) was Social stress and 07 (46.66%) wereEconomical stressGroup B: Out of fifteen patients 08 (53.33%) were Physical stress, 09 (60.00%) werePsychological stress, 07 (46.66%) was Social stress and 06 (40.00%) wereEconomical stressOverall: Out of thirty patients 16 (53.33%) were Physical stress, 15 (50.00%) werePsychological stress, 15 (50.00%) was Social stress and 13 (43.33%) wereEconomical stress.Figure 11 showing distribution of patients by Occupational History 16 16 15 15 14 13 12 P hysical stress 10 9 P sycho lo gical 8 8 8 8 6 7 7 stress 6 6 So cial stress 4 2 0 Group A Group B Total Table 26. Showing distribution of patients by Vihara Vihara Group A no. and Group B no. and Group A and B % % no. and % Hard 04 (26.66%) 05 (33.33%) 09 (30.00%) Moderate 02 (13.33%) 01 (6.66%) 03 (10.00%) Sedentary 06 (40.00%) 05 (33.33%) 11 (36.66%)Group A: Out of fifteen patients 04 (26.66%) were hard workers, 02 (13.33%) weremoderate, 06 (40.00%) were Sedentary.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 116
  • Observation & ResultsGroup B: Out of fifteen patients 05 (33.33%) were hard workers, 01 (6.66%) weremoderate and 05 (33.33%) sedentary.Overall: Out of thirty patients 09 (30.00%) were hard workers, 03 (10.00%) weremoderate and 11 (36.66%) sedentary worker. Figure 12. Showing distribution of patients by Vihara 12 11 10 16 8 Hard 6 6 5 5 Moderate 4 4 13 S edentary 2 2 1 0 G r o up A Gr o up B T o t al Table 27. Showing distribution of patients by Vyasana Vyasana Group A no. and Group B no. and Group A and B % % no. and % Tea 07 (46.66%) 10 (66.66%) 17 (56.66%) Coffee 08 (53.33%) 05 (33.33%) 13 (43.33%) Alcohal 05 (33.33%) 07 (46.66%) 12 (40.00%) Smoking 05 (33.33%) 05 (33.33%) 10 (33.33%) Tobacco 12 (80.00%) 07 (46.66%) 19 (63.33%)Group A: Out of fifteen patients, 07 (46.66%) were had Tea, 08 (53.33%) were hadthe Coffee, 05 (33.33%) were had the habit of Alcohol, 05 (33.33%) were had habit ofSmoking and 12 (80.00%) were had tobacco chewing.Group B: Out of fifteen patients, 10 (66.66%) were had Tea, 05 (33.33%) were hadthe Coffee, 07 (46.66%) were had the habit of Alcohol, 05 (33.33%) were had habit ofSmoking and 07 (46.66%) were had tobacco chewing.Overall: Out of thirty patients, 17 (56.66%) were had Tea, 13 (43.33%) were had theCoffee, 12 (40.00%) were had the habit of Alcohol, 10 (33.33%) were had habit ofSmoking and 19 (63.33%) were had tobacco chewing.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 117
  • Observation & Results Figure 13 showing distribution of patients by Vyasana 20 19 18 17 16 13 14 Te a 12 12 12 10 10 Coffe e 10 8 Alcohol 8 7 7 7 5 Smoking 6 5 5 5 4 Tobacco 2 0 Group A Group B Total Table 28 Showing distribution of patients by Satva Satva Group A no. and Group B no. and Group A and B % % no. and % Pravara 00 00 00 Madyama 06 (40.00%) 05 (33.33%) 11 (36.66%) Avara 09 (60.00%) 10 (66.66%) 19 (63.33%)Group A: Out of fifteen patients none were had Pravara, 06 (40.00%) were hadMadyama and 09 (60.00%) were had Avara.Group B: Out of fifteen patients none were had Pravara, 05 (33.33%) were hadMadyama and 10 (66.66%) were had Avara.Overall: Out of thirty patients none were had Pravara, 11 (36.66%) were hadMadyama and 19 (63.33%) were had Avara. Figure 14 showing distribution of patients by Satva 13 14 12 Pravara 10 9 8 16 Madyama 8 6 6 Samhita 6 4 Avara 4 3 3 2 0 Group A Group B Total Table 29 Showing distribution of patients by Vyayama Shakti Vyayama Shakti Group A no. and Group B no. and Group A and B % % no. and % Pravara 04 (26.66%) 04 (26.66%) 08 (26.66%) Madyama 11 (73.33%) 08 (53.33%) 19 (63.33%) Avara 00 04 (26.66%) 04 (13.33%)Group A: Out of fifteen patients, 04 (26.66%) had Pravara Vyayama Shakti, 11(73.33%) had Madyama Vyayama Shakti and none were had Avara Vyayama Shakti.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 118
  • Observation & ResultsGroup B: Out of fifteen patients, 04 (26.66%) had Pravara Vyayama Shakti, 08(53.33%) had Madyama Vyayama Shakti and 04 (26.66%) were had Avara VyayamaShakti.Overall: Out of thirty patients, 08 (26.66%) had Pravara Vyayama Shakti, 19(63.33%) had Madyama Vyayama Shakti and 04 (13.33%) were had Avara VyayamaShakti.Figure 15 showing distribution of patients by Vyayama Shakti 2 20 18 16 Pravara 14 11 Vyayama Shakti 12 M adyama 10 8 0 Vyayama Shakti 8 Avara Vyayama 6 4 4 4 4 Shakti 4 2 0 0 Group A Group B Total Table 30 Showing distribution of patients by Vaya Vaya Group A no. and Group B no. and Group A and B % % no. and % Balya 00 00 00 Madyama 15 (100%) 13 (86.66%) 28 (93.33%) Vrudda 00 02 (13.33%) 02 (6.66%)Group A: Out of fifteen patients, none (00%) were of Balya Vaya, 15 (100%) werehad Madyama Vaya and none were Vrudda.Group B: Out of fifteen patients, none (00%) were of Balya Vaya, 13 (86.66%) werehad Madyama Vaya and 02 (13.33%) were Vrudda.Overall: Out of thirty patients, none (00%) were of Balya Vaya, 28 (93.33%) werehad Madyama Vaya and 02 (6.66%) were Vrudda.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 119
  • Observation & Results Figure 16 showing distribution of patients by Vaya 17 30 25 20 15 Balya 13 15 Madyama 10 Vrudda 5 2 2 0 0 0 0 0 Group A Group B Total Table 31 Showing distribution of patients by Aharaja hetu Aharaja hetu Group A no. and Group B no. and Group A and B % % no. and % Rukshanna 07 (46.66%) 10 (66.66%) 17 (56.66%) Laghu 11 (73.33%) 07 (46.66%) 18 (60.00%) Sheeta 05 (33.33%) 07 (46.66%) 12 (40.00%) Katu 03 (20.00%) 09 (60.00%) 12 (40.00%) Alpa/ Pramitha 06 (40.00%) 06 (40.00%) 12 (40.00%)Group A: Out of fifteen patients, 07 (46.66%) were of Rukshanna, 11 (73.33%) werehad Laghu, 05 (33.33%) were Sheeta, 03 (20.00%) were Katu and 06 (40.00%) wereAlpa/Pramitha.Group B: Out of fifteen patients, 10 (66.66%) were of Rukshanna, 07 (46.66%) werehad Laghu, 07 (46.66%) were Sheeta, 09 (60.00%) were Katu and 06 (40.00%) wereAlpa/Pramitha.Overall: Out of thirty patients, 17 (56.66%) were of Rukshanna, 18 (60.00%) werehad Laghu, 12 (40.00%) were Sheeta, 12 (40.00%) were Katu and 12 (40.00%) wereAlpa/Pramitha.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 120
  • Observation & Results Figure 17 showing distribution of patients by Aharaja Hetu 18 0 17 16 14 12 12 12 11 12 10 Rukshanna 10 9 Laghu 8 7 7 7 6 6 S heeta 6 5 3 Alpa/Pramitha 4 2 0 Group A Group B Total Table 32 Showing distribution of patients by Viharaja hetu Viharaja hetu Group A no. and Group B no. and Group A and B % % no. and % Divaswapnam 08 (53.33%) 09 (60.00%) 17 (56.66%) Ati-Vyayama 04 (26.66%) 05 (33.33%) 09 (30.00%) Upavasa/ 02 (13.33%) 06 (40.00%) 08 (26.66%) Langanam Asukhashayya 07 (46.66%) 10 (66.66%) 17 (56.66%) Vishamaupachara 07 (46.66%) 09 (60.00%) 16 (53.33%) Ati-vyavaya 04 (26.66%) 05 (33.33%) 09 (30.00%) Vegadharana 09 (60.00%) 07 (46.66%) 16 (53.33%)Group A: Out of fifteen patients, 08 (53.33%) were of Divaswapnam, 04(26.66%)were had Ati-Vyayama, 02 (13.33%) were Upavasa/ Langanam, 07(46.66%) were Asukhashayya, 07 (46.66%) were Vishamaupachara, 04 (26.66%)were Ati-vyavaya and 09 (60.00%) were Vegadharana.Group B: Out of fifteen patients, 09 (60.00%) were of Divaswapnam, 05 (33.33%)were had Ati-Vyayama, 06 (40.00%) were Upavasa/ Langanam, 10 (66.66%) wereAsukhashayya, 09 (60.00%) were Vishamaupachara, 05 (33.33%) were Ati-vyavayaand 07 (46.66%) were Vegadharana.Overall: Out of thirty patients, 17 (56.66%) were of Divaswapnam, 09 (30.00%) werehad Ati-Vyayama, 08 (26.66%) were Upavasa/ Langanam, 17 (56.66%) wereAsukhashayya, 16 (53.33%) were Vishamaupachara, 09 (30.00%) were Ati-vyavayaand 16 (53.33%) were Vegadharana.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 121
  • Observation & Results Figure 18 showing distribution of patients by Viharaja hetu 18 0 17 16 16 16 Divaswapna 14 Ati-vyayama 12 10 Upavasa/Langana 10 9 9 9 17 9 8 8 Vishamaupachara 8 7 7 7 6 6 5 5 Ati-vyavaya 4 4 4 Vegadharana 2 2 0 Group A Group B Total Table 33 Showing distribution of patients by Manasika Hetu Manasika Hetu Group A no. and Group B no. and Group A and B % % no. and % Bhaya 06 (40.00%) 08 (53.33%) 14 (46.66%) Chinta 09 (60.00%) 09 (60.00%) 18 (60.00%) Krodha 06 (40.00%) 08 (53.33%) 14 (46.66%) Manasthapa 09 (60.00%) 08 (53.33%) 17 (56.66%) Vyatha 10 (66.66%) 09 (60.00%) 19 (63.33%)Group A: Out of fifteen patients, 06 (40.00%) were of Bhaya, 09 (60.00%) were hadChinta, 06 (40.00%) were Krodha, 09 (60.00%) were Manasthapa and 10 (66.66%)were Vyatha.Group B: Out of fifteen patients, 08 (53.33%) were of Bhaya, 09 (60.00%) were hadChinta, 08 (53.33%) were Krodha, 08 (53.33%) were Manasthapa and 09 (60.00%)were Vyatha.Overall: Out of thirty patients, 14 (46.66%) were of Bhaya, 18 (60.00%) were hadChinta, 14 (46.66%) were Krodha, 17 (56.66%) were Manasthapa and 19 (63.33%)were Vyatha.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 122
  • Observation & Results Figure 19 showing distribution of patients by Manasika Hetu 20 17 19 18 17 16 0 14 14 Bhaya 12 9 9 10 9 Chinta 10 8 8 8 9 8 6 6 Krodha 6 4 Vyatha 2 0 Group A Group B TotalData Related to Disease Table No 34: Showing the distribution of patients by different grades of Sleep History Questionaire before treatment Sleep History Group A no. and Group B no. and Group A and B Questionaire % % no. and % Grade 0 00 00 00 Grade 1 00 00 00 Grade 2 05 (33.33%) 07 (46.66%) 12 (40.00%) Grade 3 10 (66.66%) 08 (53.33%) 18 (60.00%) Grade 4 00 00 00Group A: Out of fifteen patients, none were complained 01 to 20%, none werecomplained 21 to 40%, 05 (33.33%) were complained 41 to 60%, 10 (66.66%) werecomplained 61 to 80% and none were had 81 to 100% before treatmentGroup B: Out of fifteen patients, none were complained 01 to 20%, none werecomplained 21 to 40%, 07 (46.66%) were complained 41 to 60%, 08 (53.33%) werecomplained 61 to 80% and none were had 81 to 100% before treatmentOverall: Out of thirty patients, none were complained 01 to 20%, none werecomplained 21 to 40%, 12 (40.00%) were complained 41 to 60%, 18 (60.00%) werecomplained 61 to 80%and none were had 81 to 100% before treatment“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 123
  • Observation & Results Figure 20 showing distribution of patients by different grades of Sleep History Questionaire before treatment 18 18 16 14 12 12 10 Grade 0 10 8 Grade 1 7 8 Grade 2 6 5 Grade 3 4 Grade 4 2 0 0 0 0 0 0 0 0 0 0 Group A Group B Total Table No 35: Showing the distribution of patients by different grades of Sleep History Questionaire after treatment Sleep History Group A no. and Group B no. and Group A and B Questionaire % % no. and % Grade 0 03 (20.00%) 12 (80.00%) 15 (50.00%) Grade 1 02 (13.33%) 00 02 (6.66%) Grade 2 05 (33.33%) 03 (20.00%) 08 (26.66%) Grade 3 05 (33.33%) 00 05 (16.66%) Grade 4 00 00 00Group A: Out of fifteen patients, 03 (20.00%) were complained 01 to 20%, 02(13.33%) were complained 21 to 40%, 05 (33.33%) were complained 41 to 60%, 05(33.33%) were complained 61 to 80% and none were had 81 to 100% after treatmentGroup B: Out of fifteen patients, 12 (80.00%) were complained 01 to 20%, none werecomplained 21 to 40%, 03 (20.00%) were complained 41 to 60%, none werecomplained 61 to 80% and none were had 81 to 100% after treatmentOverall: Out of thirty patients, 15 (50.00%) were complained 01 to 20%, 02 (6.66%)were complained 21 to 40%, 08 (26.66%) were complained 41 to 60%, 05 (16.66%)were complained 61 to 80%and none were had 81 to 100% after treatment“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 124
  • Observation & Results Figure 21 showing distribution of patients by different grades of Sleep History Questionaire after treatment 16 15 14 12 12 Grade 0 10 8 Grade 1 8 Grade 2 6 5 5 5 Grade 3 4 3 3 2 2 Grade 4 2 0 0 0 0 0 0 Group A Group B TotalSubjective Parameter: Table No 36: Showing the distribution of patients by different grades of Angamarda before treatment Angamarda Group A no. and Group B no. and Group A and B % % no. and % Grade 0 04 (26.66%) 06 (40.00%) 10 (33.33%) Grade 1 11 (73.33%) 09 (60.00%) 20 (66.66%)Group A: Out of fifteen patients, 04 (26.66%) were complained Grade 0 and 11(73.33%) were had Grade 1 before treatmentGroup B: Out of fifteen patients, 06 (40.00%) were complained Grade 0 and 09(60.00%) were had Grade 1 before treatmentOverall: Out of thirty patients, 10 (33.33%) were complained Grade 0 and 20(66.66%) were had Grade 1 before treatment Figure 22 showing distribution of patients by different grades of Angamarda before treatment 20 20 18 16 14 11 10 12 9 10 Grade 0 6 8 Grade 1 4 6 4 2 0 Group A Group B Total“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 125
  • Observation & Results Table No 37 Showing the distribution of patients by different grades of Angamarda after treatment Angamarda Group A no. and Group B no. and Group A and B % % no. and % Grade 0 10 (66.66%) 13 (86.66%) 23 (76.66%) Grade 1 05 (33.33%) 02 (13.33%) 07 (23.33%)Group A: Out of fifteen patients, 10 (66.66%) were complained Grade 0 and 05(33.33%) were had Grade 1 after treatmentGroup B: Out of fifteen patients, 13 (86.66%) were complained Grade 0 and 02(13.33%) were had Grade 1 after treatmentOverall: Out of thirty patients, 23 (76.66%) were complained Grade 0 and 07(23.33%) were had Grade 1 after treatment Figure 23 showing distribution of patients by different grades of Angamarda after treatment 23 25 20 13 15 10 Grade 0 7 10 5 Grade 1 2 5 0 Group A Group B Total Table No 38 Showing the distribution of patients by different grades of Shirogaurava before treatment Shirogaurava Group A no. and Group B no. and Group A and B % % no. and % Grade 0 02 (13.33%) 03 (20.00%) 05 (16.66%) Grade 1 13 (86.66%) 12 (80.00%) 25 (83.33%)Group A: Out of fifteen patients, 02 (13.33%) were complained Grade 0 and 13(86.66%) were had Grade 1 before treatmentGroup B: Out of fifteen patients, 03 (20.00%) were complained Grade 0 and 12(80.00%) were had Grade 1 before treatmentOverall: Out of thirty patients, 05 (16.66%) were complained Grade 0 and 25(83.33%) were had Grade 1 before treatment“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 126
  • Observation & Results Figure 24 showing distribution of patients by different grades of Shirogaurava before treatment 23 25 20 15 15 8 Grade 0 7 7 10 Grade 1 5 0 0 Group A Group B Total Table No 39 Showing the distribution of patients by different grades of Shirogaurava after treatment Shirogaurava Group A no. and Group B no. and Group A and B % % no. and % Grade 0 08 (53.33%) 15 (100%) 23 (76.66%) Grade 1 07 (46.66%) 00 07 (23.33%)Group A: Out of fifteen patients, 08 (53.33%) were complained Grade 0 and 07(46.66%) were had Grade 1 after treatmentGroup B: Out of fifteen patients, 15 (100%) were complained Grade 0 and none werehad Grade 1 after treatmentOverall: Out of thirty patients, 23 (76.66%) were complained Grade 0 and 07(23.33%) were had Grade 1 after treatment Figure 25 showing distribution of patients by different grades of Shirogaurava after treatment 23 25 20 15 15 8 Grade 0 7 7 10 Grade 1 5 0 0 Group A Group B Total“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 127
  • Observation & ResultsTable No 40 Showing the distribution of patients by different grades of Jrumbha before treatment Jrumbha Group A no. and Group B no. and Group A and B % % no. and % Grade 0 08 (53.33%) 09 (60.00%) 17 (56.66%) Grade 1 07 (46.66%) 06 (40.00%) 13 (43.33%)Group A: Out of fifteen patients, 08 (53.33%) were complained Grade 0 and 07(46.66%) were had Grade 1 before treatmentGroup B: Out of fifteen patients, 09 (60.00%) were complained Grade 0 and 06(40.00%) were had Grade 1 before treatmentOverall: Out of thirty patients, 17 (56.66%) were complained Grade 0 and 13(43.33%) were had Grade 1 before treatmentFigure 26 showing distribution of patients by different grades of Jrumbha before treatment 17 18 16 13 14 9 12 8 10 7 6 Grade 0 8 Grade 1 6 4 2 0 Group A Group B TotalTable No 41 Showing the distribution of patients by different grades of Jrumbha after treatment Jrumbha Group A no. and Group B no. and Group A and B % % no. and % Grade 0 15 (100%) 15 (100%) 30 (100%) Grade 1 00 00 00Group A: Out of fifteen patients, 15 (100%) were complained Grade 0 and none werehad Grade 1 after treatmentGroup B: Out of fifteen patients, 15 (100%) were complained Grade 0 and none werehad Grade 1 after treatment“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 128
  • Observation & ResultsOverall: Out of thirty patients, 30 (100%) were complained Grade 0 and none werehad Grade 1 after treatment Figure 27 showing distribution of patients by different grades of Jrumbha after treatment 30 30 25 20 15 15 15 Grade 0 Grade 1 10 5 0 0 0 0 Group A Group B Total Table No 42 Showing the distribution of patients by different grades of Sleeplessness before treatment Sleeplessness Group A no. and Group B no. and Group A and B % % no. and % Grade 0 00 00 00 Grade 1 00 00 00 Grade 2 06 (40.00%) 06 (40.00%) 12 (40.00%) Grade 3 06 (40.00%) 03 (20.00%) 09 (30.00%) Grade 4 03 (20.00%) 06 (40.00%) 09 (30.00%)Group A: Out of fifteen patients, none were complained Grade 0, none werecomplained Grade 1, 06 (40.00%) were complained Grade 2, 06 (40.00%) werecomplained Grade 3 and 03 (20.00%) were had Grade 4 before treatmentGroup B: Out of fifteen patients, none were complained Grade 0, none werecomplained Grade 1, 06 (40.00%) were complained Grade 2, 03 (20.00%) werecomplained Grade 3 and 06 (40.00%) were had Grade 4 before treatmentOverall: Out of thirty patients, none were complained Grade 0, none were complainedGrade 1, 12 (40.00%) were complained Grade 2, 09 (30.00%) were complained Grade3 and 09 (30.00%) were had Grade 4 before treatment“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 129
  • Observation & Results Figure 28 showing distribution of patients by different grades of Sleeplessness before treatment 12 12 10 9 9 Grade 0 8 6 6 6 6 Grade 1 6 Grade 2 4 3 3 Grade 3 2 Grade 4 0 0 0 0 0 0 0 Group A Group B Total Table No 43 Showing the distribution of patients by different grades of Sleeplessness after treatment Sleeplessness Group A no. and Group B no. and Group A and B % % no. and % Grade 0 02 (13.33%) 07 (46.66%) 09 (30.00%) Grade 1 05 (33.33%) 08 (53.33%) 13 (43.33%) Grade 2 08 (53.33%) 00 08 (26.66%) Grade 3 00 00 00 Grade 4 00 00 00Group A: Out of fifteen patients, 02 (13.33%) were complained Grade 0, 05 (33.33%)were complained Grade 1, 08 (53.33%) were complained Grade 2, none werecomplained Grade 3 and none were had Grade 4 after treatmentGroup B: Out of fifteen patients, 07 (46.66%) were complained Grade 0, 08 (53.33%)were complained Grade 1, none were complained Grade 2, none were complainedGrade 3 and none were had Grade 4 after treatmentOverall: Out of thirty patients, 09 (30.00%) were complained Grade 0, 13 (43.33%)were complained Grade 1, 08 (26.66%) were complained Grade 2, none werecomplained Grade 3 and none were had Grade 4 after treatment.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 130
  • Observation & Results Figure 29 showing distribution of patients by different grades of Sleeplessness after treatment 14 13 12 10 9 8 8 8 Grade 0 8 7 Grade 1 6 5 Grade 2 Grade 3 4 2 Grade 4 2 0 0 0 0 0 0 0 0 Group A Group B TotalTable No 44 Showing the distribution of patients by different grades of Difficulty in Initiating Sleep before treatment Difficulty in Group A no. and Group B no. and Group A and B Initiating Sleep % % no. and % Grade 0 00 00 00 Grade 1 01 (6.66%) 00 01 (3.33%) Grade 2 05 (33.33%) 07 (46.66%) 12 (40.00%) Grade 3 09 (60.00%) 08 (53.33%) 17 (56.66%)Group A: Out of fifteen patients, none were complained Grade 0, 01 (6.66%) werecomplained Grade 1, 05 (33.33%) were complained Grade 2 and 09 (60.00%) werecomplained Grade 3 before treatmentGroup B: Out of fifteen patients, none were complained Grade 0, none werecomplained Grade 1, 07 (46.66%) were complained Grade 2 and 08 (53.33%) werecomplained Grade 3 before treatmentOverall: Out of thirty patients, none were complained Grade 0, 01 (3.33%) werecomplained Grade 1, 12 (40.00%) were complained Grade 2 and 17 (56.66%) werecomplained Grade 3 before treatment“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 131
  • Observation & Results Figure 30 showing distribution of patients by different grades of Difficulty in Initiating Sleep before treatment 17 18 16 14 12 12 9 Grade 0 10 7 8 Grade 1 8 5 Grade 2 6 Grade 3 4 1 1 2 0 0 0 0 0 Group A Group B TotalTable No 45 Showing the distribution of patients by different grades of Difficulty in Initiating Sleep after treatment Difficulty in Group A no. and Group B no. and Group A and B Initiating Sleep % % no. and % Grade 0 04 (26.66%) 14 (93.33%) 18 (60.00%) Grade 1 09 (60.00%) 01 (6.66%) 10 (33.33%) Grade 2 02 (13.33%) 00 02 (6.66%) Grade 3 00 00 00Group A: Out of fifteen patients, 04 (26.66%) were complained Grade 0, 09 (60.00%)were complained Grade 1, 02 (13.33%) were complained Grade 2 and none werecomplained Grade 3 after treatmentGroup B: Out of fifteen patients, 14 (93.33%) were complained Grade 0, 01 (6.66%)were complained Grade 1, none were complained Grade 2 and none were complainedGrade 3 after treatmentOverall: Out of thirty patients, 18 (60.00%) were complained Grade 0, 10 (33.33%)were complained Grade 1, 02 (6.66%) were complained Grade 2 and none werecomplained Grade 3 after treatment.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 132
  • Observation & Results Figure 31 showing distribution of patients by different grades of Difficulty in Initiating Sleep after treatment 18 18 16 14 14 12 10 Grade 0 9 10 Grade 1 8 Grade 2 6 4 Grade 3 4 2 2 1 2 0 0 0 0 0 Group A Group B Total Table No 46 Showing the distribution of patients by different grades of Sleep Quality before treatment Sleep Quality Group A no. and Group B no. and Group A and B % % no. and % Grade 0 00 00 00 Grade 1 00 00 00 Grade 2 06 (40.00%) 03 (20.00%) 09 (30.00%) Grade 3 09 (60.00%) 12 (80.00%) 21 (70.00%)Group A: Out of fifteen patients, none were complained Grade 0, none werecomplained Grade 1, 06 (40.00%) were complained Grade 2 and 09 (60.00%) werecomplained Grade 3 before treatmentGroup B: Out of fifteen patients, none were complained Grade 0, none werecomplained Grade 1, 03 (20.00%) were complained Grade 2 and 12 (80.00%) werecomplained Grade 3 before treatmentOverall: Out of thirty patients, none were complained Grade 0, none were complainedGrade 1, 09 (30.00%) were complained Grade 2 and 21 (70.00%) were complainedGrade 3 before treatment“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 133
  • Observation & Results Figure 32 showing distribution of patients by different grades of Sleep Quality before treatment 25 21 20 Grade 0 15 12 Grade 1 9 9 10 Grade 2 6 Grade 3 5 3 0 0 0 0 0 0 0 Group A Group B Total Table No 47 Showing the distribution of patients by different grades of Sleep Quality after treatment Sleep Quality Group A no. and Group B no. and Group A and B % % no. and % Grade 0 03 (20.00%) 12 (80.00%) 15 (50.00%) Grade 1 09 (60.00%) 03 (20.00%) 12 (40.00%) Grade 2 03 (20.00%) 00 03 (10.00%) Grade 3 00 00 00Group A: Out of fifteen patients, 03 (20.00%) were complained Grade 0, 09 (60.00%)were complained Grade 1, 03 (20.00%) were complained Grade 2 and none werecomplained Grade 3 after treatmentGroup B: Out of fifteen patients, 12 (80.00%) were complained Grade 0, 03 (20.00%)were complained Grade 1, none were complained Grade 2 and none were complainedGrade 3 after treatmentOverall: Out of thirty patients, 15 (50.00%) were complained Grade 0, 12 (40.00%)were complained Grade 1, 03 (10.00%) were complained Grade 2 and none werecomplained Grade 3 after treatment.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 134
  • Observation & Results Figure 33 showing distribution of patients by different grades of Sleep Quality after treatment 15 16 14 12 12 12 10 9 Grade 0 8 Grade 1 6 Grade 2 4 3 3 3 3 Grade 3 2 0 0 0 0 0 Group A Group B Total Table No 48 Showing the distribution of patients by different grades of Performance of daily activities before treatment Performance of Group A no. and Group B no. and Group A and B daily activities % % no. and % Grade 0 00 00 00 Grade 1 00 00 00 Grade 2 05 (33.33%) 05 (33.33%) 10 (33.33%) Grade 3 10 (66.66%) 10 (66.66%) 20 (66.66%)Group A: Out of fifteen patients, none were complained Grade 0, none werecomplained Grade 1, 05 (33.33%) were complained Grade 2 and 10 (66.66%) werecomplained Grade 3 before treatmentGroup B: Out of fifteen patients, none were complained Grade 0, none werecomplained Grade 1, 05 (33.33%) were complained Grade 2 and 10 (66.66%) werecomplained Grade 3 before treatmentOverall: Out of thirty patients, none were complained Grade 0, none were complainedGrade 1, 10 (33.33%) were complained Grade 2 and 20 (66.66%) were complainedGrade 3 before treatment“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 135
  • Observation & ResultsFigure 34 showing distribution of patients by different grades of Performance of daily activities before treatment 20 20 18 16 14 Grade 0 12 10 10 10 10 Grade 1 8 5 5 Grade 2 6 4 Grade 3 2 0 0 0 0 0 0 0 Group A Group B Total Table No 49 Showing the distribution of patients by different grades of Performance of daily activities after treatment Performance of Group A no. and Group B no. and Group A and B daily activities % % no. and % Grade 0 03 (20.00%) 13 (86.66%) 16 (53.33%) Grade 1 10 (66.66%) 01 (6.66%) 11 (36.66%) Grade 2 02 (13.33%) 01 (6.66%) 03 (10.00%) Grade 3 00 00 00Group A: Out of fifteen patients, 03 (20.00%) were complained Grade 0, 10 (66.66%)were complained Grade 1, 02 (13.33%) were complained Grade 2 and none werecomplained Grade 3 after treatmentGroup B: Out of fifteen patients, 13 (86.66%) were complained Grade 0, 01 (6.66%)were complained Grade 1, 01 (6.66%) were complained Grade 2 and none werecomplained Grade 3 after treatmentOverall: Out of thirty patients, 16 (53.33%) were complained Grade 0, 11 (36.66%)were complained Grade 1, 03 (10.00%) were complained Grade 2 and none werecomplained Grade 3 after treatment.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 136
  • Observation & ResultsFigure 35 showing distribution of patients by different grades of Performance of daily activities after treatment 16 16 14 13 11 12 10 10 Grade 0 8 Grade 1 6 Grade 2 4 3 3 Grade 3 2 1 1 2 0 0 0 0 Group A Group B Total Table No 50 Showing the distribution of patients by different grades of Vitality after Morning Awakening before treatment Vitality after Group A no. and Group B no. and Group A and B Morning % % no. and % Awakening. Grade 0 00 00 00 Grade 1 00 00 00 Grade 2 06 (40.00%) 07 (46.66%) 13 (43.33%) Grade 3 09 (60.00%) 08 (53.33%) 17 (56.66%)Group A: Out of fifteen patients, none were complained Grade 0, none werecomplained Grade 1, 06 (40.00%)were complained Grade 2 and 09 (60.00%)werecomplained Grade 3 before treatmentGroup B: Out of fifteen patients, none were complained Grade 0, none werecomplained Grade 1, 07 (46.66%) were complained Grade 2 and 08 (53.33%) werecomplained Grade 3 before treatmentOverall: Out of thirty patients, none were complained Grade 0, none were complainedGrade 1, 13 (43.33%) were complained Grade 2 and 17 (56.66%) were complainedGrade 3 before treatment“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 137
  • Observation & Results Figure 36 showing distribution of patients by different grades of Vitality after Morning Awakening before treatment 17 18 16 13 14 12 9 Grade 0 10 7 8 Grade 1 8 6 Grade 2 6 Grade 3 4 2 0 0 0 0 0 0 0 Group A Group B Total Table No 51 Showing the distribution of patients by different grades of Vitality after Morning Awakening after treatment Vitality after Group A no. and Group B no. and Group A and B Morning % % no. and % Awakening. Grade 0 03 (20.00%) 12 (80.00%) 15 (50.00%) Grade 1 09 (60.00%) 03 (20.00%) 12 (40.00%) Grade 2 03 (20.00%) 00 03 (10.00%) Grade 3 00 00 00Group A: Out of fifteen patients, 03 (20.00%) were complained Grade 0, 09 (60.00%)were complained Grade 1, 03 (20.00%) were complained Grade 2 and none werecomplained Grade 3 after treatmentGroup B: Out of fifteen patients, 12 (80.00%) were complained Grade 0, 03 (20.00%)were complained Grade 1, none were complained Grade 2 and none were complainedGrade 3 after treatmentOverall: Out of thirty patients, 15 (50.00%) were complained Grade 0, 12 (40.00%)were complained Grade 1, 03 (10.00%) were complained Grade 2 and none werecomplained Grade 3 after treatment.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 138
  • Observation & Results Figure 37 showing distribution of patients by different grades of Vitality after Morning Awakening after treatment 16 15 14 12 12 12 9 10 Grade 0 8 Grade 1 6 Grade 2 4 3 3 3 3 Grade 3 2 0 0 0 0 0 Group A Group B TotalObjective Parameter: Table No 52 Showing the distribution of patients by different grades of Total Sleep Time before treatment Total Sleep Time Group A no. and Group B no. and Group A and B % % no. and % Grade 0 00 00 00 Grade 1 01 (6.66%) 00 01 (3.33%) Grade 2 05 (33.33%) 06 (40.00%) 11 (36.66%) Grade 3 06 (40.00%) 03 (20.00%) 09 (30.00%) Grade 4 03 (20.00%) 06 (40.00%) 09 (30.00%)Group A: Out of fifteen patients, none were complained Grade 0, 01 (6.66%) werecomplained Grade 1, 05 (33.33%) were complained Grade 2, 06 (40.00%) werecomplained Grade 3 and 03 (20.00%) were had Grade 4 before treatmentGroup B: Out of fifteen patients, none were complained Grade 0, none werecomplained Grade 1, 06 (40.00%) were complained Grade 2, 03 (20.00%) werecomplained Grade 3 and 06 (40.00%) were had Grade 4 before treatmentOverall: Out of thirty patients, none were complained Grade 0, 01 (3.33%) werecomplained Grade 1, 11 (36.66%) were complained Grade 2, 09 (30.00%) werecomplained Grade 3 and 09 (30.00%) were had Grade 4 before treatment“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 139
  • Observation & Results Figure 38 showing distribution of patients by different grades of Total Sleep Time before treatment 12 11 10 9 9 8 Grade 0 6 6 6 Grade 1 6 5 Grade 2 4 3 3 Grade 3 Grade 4 2 1 1 0 0 0 0 0 Group A Group B Total Table No 53 Showing the distribution of patients by different grades of Total Sleep Time after treatment Total Sleep Time Group A no. and Group B no. and Group A and B % % no. and % Grade 0 03 (20.00%) 12 (80.00%) 15 (50.00%) Grade 1 06 (40.00%) 03 (20.00%) 09 (30.00%) Grade 2 05 (33.33%) 00 05 (16.66%) Grade 3 01 (6.66%) 00 01 (3.33%) Grade 4 00 00 00Group A: Out of fifteen patients, 03 (20.00%) were complained Grade 0, 06 (40.00%)were complained Grade 1, 05 (33.33%) were complained Grade 2, 01 (6.66%) werecomplained Grade 3 and none were had Grade 4 after treatmentGroup B: Out of fifteen patients, 12 (80.00%) were complained Grade 0, 03 (20.00%)were complained Grade 1, none were complained Grade 2, none were complainedGrade 3 and none were had Grade 4 after treatmentOverall: Out of thirty patients, 15 (50.00%) were complained Grade 0, 09 (30.00%)were complained Grade 1, 05 (16.66%) were complained Grade 2, 01 (3.33%) werecomplained Grade 3 and none were had Grade 4 after treatment.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 140
  • Observation & Results Figure 39 showing distribution of patients by different grades of Total Sleep Time after treatment 16 15 14 12 12 9 Grade 0 10 Grade 1 8 6 Grade 2 5 5 6 Grade 3 4 3 3 Grade 4 2 1 1 0 0 0 0 0 0 Group A Group B Total Table No 54 Showing the distribution of patients by different grades of Wakefulness During Sleep before treatment Wakefulness Group A no. and Group B no. and Group A and B During Sleep % % no. and % Grade 0 00 00 00 Grade 1 03 (20.00%) 03 (20.00%) 06 (20.00%) Grade 2 05 (33.33%) 05 (33.33%) 10 (33.33%) Grade 3 07 (46.66%) 07 (46.66%) 14 (46.66%)Group A: Out of fifteen patients, none were complained Grade 0, 03 (20.00%) werecomplained Grade 1, 05 (33.33%) were complained Grade 2 and 07 (46.66%) werecomplained Grade 3 before treatmentGroup B: Out of fifteen patients, none were complained Grade 0, 03 (20.00%) werecomplained Grade 1, 05 (33.33%) were complained Grade 2 and 07 (46.66%) werecomplained Grade 3 before treatmentOverall: Out of thirty patients, none were complained Grade 0, 06 (20.00%) werecomplained Grade 1, 10 (33.33%) were complained Grade 2 and 14 (46.66%) werecomplained Grade 3 before treatment“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 141
  • Observation & Results Figure 40 showing distribution of patients by different grades of Wakefulness During Sleep before treatment 14 14 12 10 10 7 7 Grade 0 8 6 Grade 1 6 5 5 Grade 2 4 3 3 Grade 3 2 0 0 0 0 Group A Group B Total Table No 55 Showing the distribution of patients by different grades of Wakefulness During Sleep after treatment Wakefulness Group A no. and Group B no. and Group A and B During Sleep % % no. and % Grade 0 03 (20.00%) 12 (80.00%) 15 (50.00%) Grade 1 09 (60.00%) 03 (20.00%) 12 (40.00%) Grade 2 03 (20.00%) 00 03 (10.00%) Grade 3 00 00 00Group A: Out of fifteen patients, 03 (20.00%) were complained Grade 0, 09 (60.00%)were complained Grade 1, 03 (20.00%) were complained Grade 2 and none werecomplained Grade 3 after treatmentGroup B: Out of fifteen patients, 12 (80.00%) were complained Grade 0, 03 (20.00%)were complained Grade 1, none were complained Grade 2 and none were complainedGrade 3 after treatmentOverall: Out of thirty patients, 15 (50.00%) were complained Grade 0, 12 (40.00%)were complained Grade 1, 03 (10.00%) were complained Grade 2 and none werecomplained Grade 3 after treatment.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 142
  • Observation & Results Figure 41 showing distribution of patients by different grades of Wakefulness During Sleep after treatment 15 16 14 12 12 12 10 9 Grade 0 8 Grade 1 6 Grade 2 4 3 3 3 3 Grade 3 2 0 0 0 0 0 Group A Group B TotalObservation of the data related to the response of the patient Table No 56 Showing the distribution of Overall Response to the treatment Duration Group A no. and Group B no. and Group A and B % % no. and % Good Response 02 (13.33%) 12 (80.00%) 14 (46.66%)Moderate Response 10 (66.66%) 03 (20.00%) 13 (43.33%) Poor Response 03 (20.00%) 00 03 (10.00%) No Response 00 00 00Group A: Out of fifteen patients, 02 (13.33%) shown Good response to the treatment.10 (66.66%) were shown Moderate response, 03 (20.00%) patients shown Poorresponse and none were shown No response.Group B: Out of fifteen patients 12 (80.00%) were shown Good response to thetreatment. 03 (20.00%) were shown Moderate response, none patients shown Poorresponse, none were shown No response.Overall: Out of thirty patients, only 14 (46.66%) patient shown Good response to thetreatment. 13 (43.33%) were shown Moderate response, 03 (10.00%) patients shownPoor response and none were shown No response.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 143
  • Observation & ResultsFigure no. 42 showing the distribution of Overall Response to the treatment 14 14 13 12 12 10 10 8 Good Re sponse Mode rate Re sponse 6 Poor Re sponse 4 3 3 3 No Re sponse 2 2 0 0 0 0 0 Group A Group B TotalObservation of the statistical out comes of the study: Table no 57 showing the Comparative Study of Group A and Group B after treatment Parameter Group Mean SD SE PSE T- P- Remarks Value Value AM A 0.333 0.487 0.126 0.154 1.29 >0.05 NS B 0.133 0.351 0.090 SG A 0.466 0.516 0.133 0.133 3.50 <0.01 HS B 0.00 0.00 0.00 JB A 0.00 0.00 0.00 - - - - B 0.00 0.00 0.00 SL A 1.4 0.736 0.190 0.231 3.75 <0.001 HS B 0.533 0.516 0.133 DIS A 0.866 0.639 0.165 0.177 4.51 <0.001 HS B 0.066 0.258 0.066 SQ A 1.00 0.654 0.169 0.181 4.41 <0.001 HS B 0.2 0.414 0.106 PDQ A 0.933 0.593 0.153 0.213 3.49 <0.01 HS B 0.2 0.560 0.144 VMA A 1.00 0.654 0.169 0.199 4.02 <0.001 HS B 0.2 0.414 0.106 TST A 1.266 0.883 0.228 0.251 4.24 <0.001 HS B 0.2 0.414 0.106 WDS A 1.00 0.654 0.16 0.191 4.18 <0.001 HS B 0.2 0.414 0.106 SL Q A 1.8 1.146 0.296 0.364 3.84 <0.001 HS B 0.4 0.828 0.213 To know compare the effectiveness of the treatment procedure, the statisticalanalysis is done by using Un-paired t-test, by assuming that the mean effect treatmentprocedures is same in both the groups after treatment procedure. From the analysisexcept the Angamarda all other parameters shows more significant (as P<0.05). i.e.,“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 144
  • Observation & Resultsthe mean effects treatment procedure is not same as in all other parameters. But inJrumbha parameter there is no significance difference after the treatment. Table no 58 showing Individual study of group-AParameter Mean Net SD SE T- P-value Remarks BT AT Mean value AM 0.733 0.333 0.4 0.507 0.13 3.07 <0.01 HS SG 0.866 0.466 0.4 0.507 0.13 3.07 <0.01 HS JB 0.466 0.0 0.466 0.516 0.133 3.50 <0.01 HS SL 2.8 1.4 2.533 0.639 0.165 15.35 <0.001* HS DIS 2.533 0.866 1.66 0.487 0.126 13.17 <0.001* HS SQ 2.6 1.0 1.6 0.632 0.163 9.81 <0.001* HS PDA 2.66 0.933 1.733 0.457 0.118 14.68 <0.001* HS VMA 2.6 1.0 1.6 0.507 0.13 12.30 <0.001* HS TST 2.733 1.266 1.466 0.639 0.165 8.88 <0.001* HS WDS 2.266 1.00 1.266 0.798 0.206 6.14 <0.001* HS SLQ 2.66 1.8 0.866 0.743 0.191 4.53 <0.001* HS Table no 59 showing Individual study of group-BParameter Mean Net SD SE T- P-value Remarks BT AT Mean value AM 0.6 0.133 0.466 0.516 0.133 3.50 <0.01 HS SG 0.8 0.0 0.8 0.414 0.106 7.54 <0.001* HS JB 0.4 0.0 0.4 0.507 0.13 3.07 <0.01 HS SL 3.0 0.533 2.466 0.639 0.165 14.94 <0.001* HS DIS 2.533 0.066 2.466 0.516 0.133 18.54 <0.001* HS SQ 2.8 0.2 2.6 0.507 0.130 20.00 <0.001* HS PDA 2.66 0.2 2.466 0.639 0.165 14.94 <0.001* HS VMA 2.533 0.2 2.333 0.617 0.159 14.67 <0.001* HS TST 3.0 0.2 2.8 0.774 0.2 14.00 <0.001* HS WDS 2.2 0.2 2.0 0.654 0.169 11.83 <0.001* HS SLQ 2.533 0.4 2.133 0.915 0.236 9.03 <0.001* HS To know on which parameters the treatment procedure is more effective, thestatistical analysis is done by using paired t-test, by assuming that the treatmentprocedure is same in both groups in all the parameters. From the analysis allparameters shows highly significant as P<0.05.From the analysis in Group B(Yastiksheera Dhara) the parameter Angamarda, Shirogaurava, Difficulty in initiatingSleep, Sleep Quality, Performance of Daily Activity, Vitality after MorningAwakening, Total Sleep Time, Wakefulness during Sleep and Sleep Question shows“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 145
  • Observation & Resultsmore highly significant than Group A (Sarpi Nasya). In Group A (Sarpi nasya) theparameter Jrumba and Sleeplessness shows more highly significant than Group B(Yastiksheera Dhara). But the parameter PDA shows equal effect in Group A andGroup B.Conclusion: Over all the Group B (Yastiksheera Dhara) is better than Group A (SarpiNasya) in most parameters. The parameter Jrumba is not significant means thisparameter is not necessary for this study. Further study can be conducted byconsidering sample by Age, Sex, and Profession and by extending duration of thetreatment.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 146
  • Demographic DataGroup – A: Table no 60 Showing Demographical DataSl. OPD Age Sex Religion Occupation Economical Marital Responseno No. Yrs status Status M F H M C O St L E S P M H M U G M P N 1 8681 45 - + - - + - - - - + - + - + - - + - - 2 12224 21 - + + - - - + - - - - + - - + - + - - 3 14194 33 + - + - - - - + - - + - - + - - + - - 4 14725 30 + - + - - - - - + - - - + + - - + - - 5 17017 40 + - + - - - - - - + - - + + - - + - - 6 18197 31 + - + - - - - + - - + - - - + - + - - 7 18225 21 + - + - - - + - - - - - + - + + - - - 8 18230 40 - + + - - - - - - + - + - + - - + - - 9 19051 46 - + + - - - - - - + - + - + - - - + -10 19086 20 - + + - - - + - - - - + - - + + - - -11 19225 30 - + + - - - - - - + - - + + - - + - -12 19495 31 + - + - - - - - + - - + - + - - + - -13 19973 49 + - + - - - - + - - + - - + - - - + -14 23776 30 + - + - - - - - - + + - - - + - + - -15 23775 46 + - + - - - - + - - + - - + - - - + -Sex: M – male, F – female.Religion: H- Hindu, M – Muslim, C – Christian, O – others.Occupation: S – student, L – labor, E – executive, S – sedentary.Economical status: P – poor, M– middle class H– higher class.Response: G – Good response, M – Moderate response, P – Poor response, N – No response. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 147
  • Demographic DataGroup – B: Table no 61 Showing Demographical DataSl. OPD Age Sex Religion Occupation Economical Marital Responseno No. Yrs status Status M F H M C O St L E S P M H M U G M P N16 5462 37 + - + - - - - + - - + - - + - + - - -17 5467 47 - + - - + - - - - + - + - + - + - - -18 5514 60 - + + - - - - - - + - + - + - - + - -19 6491 21 + - - - + - + - - - - - + + - + - - -20 7406 48 - + + - - - - - - + - - + + - + - - -21 2873 25 + - + - - - + - - - - - + - + + - - -22 2852 26 + - + - - - + - - - - + - - + + - - -23 3120 25 + - + - - - - + - - + - - - + + - - -24 3073 65 + - + - - - - + - - + - - + - - + - -25 8582 21 + - + - - - + - - - - - + - + + - - -26 14766 29 - + - + - - - - - + - + - + - + - - -27 18807 42 + - + - - - - + - - + - - + - - + - -28 19073 28 + - + - - - - - + - - - + - + + - - -29 19535 29 + - - + - - - - - + - + - + - + - - -30 23895 25 + - + - - - - + - - + - - - + + - - -Sex: M – male, F – female.Religion: H- Hindu, M – Muslim, C – Christian, O – others.Occupation: S – student, L – labor, E – executive, S – sedentary.Economical status: P – poor, M– middle class H– higher class.Response: G – Good response, M – Moderate response, P – Poor response, N – No response. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 148
  • Demographic DataGroup – A: Table no 62 Showing Demographical Data Pradhana Vedhana Anubanda vedana Sl. OPD RS DS WS JB SG AM BR AP SS no No. P A P A P A P A P A P A P A P A P A 1 8681 + - + - + - + - + - + - + - + - + - 2 12224 + - - + + - + - + - - + - + - + + - 3 14194 - + + - + - - + + - + - - + - + - + 4 14725 + - + - - + - + + - - + - + + - + - 5 17017 + - + - + - + - + - + - + - - + - + 6 18197 - + + - + - - + + - + - - + - + + - 7 18225 + - - + + - + - + - - + - + + - + - 8 18230 + - + - + - - + + - + - + - + - + - 9 19051 + - + - + - - + + - + - + - - + - + 10 19086 - + - + + - + - - + + - - + + - - - 11 19225 + - + - + - - + + - + - - + - + + - 12 19495 + - - + + - + - + - - + - + + - + - 13 19973 + - - + - + - + + - + - + - + - + - 14 23776 - + + - - + + - - + + - + - - + - + 15 23775 + - + - + - - + + - + - + - + - + -Pradhana Vedana: RS - Reduction in sleep time, DS - Difficulty in initiating sleep, WS - Wakefulness during sleepAnubanda vedana: JB – Jrumbha, SG – Shirogaurava, AM – Angamarda, BR – Bhrama, AP – Apakti, SS - ShirashoolaP – Present, A - Absent “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 149
  • Demographic DataGroup – B: Table no 63 Showing Demographical Data Pradhana Vedana Anubanda vedana Sl. OPD RS DS WS JB SG AM BR AP SS no No. P A P A P A P A P A P A P A P A P A 16 5462 - + + - + - - + + - + - - + - + + - 17 5467 + - + - + - - + + - + - + - + - + - 18 5514 + - + - + - + - + - + - + - + - + - 19 6491 - + - + + - + - + - - + - + - + - + 20 7406 + - + - + - - + - + + - + - + - + - 21 2873 + - + - - + + - + - - + - + - + - + 22 2852 - + + - + - + - + - - + - + - + - + 23 3120 - + - + + - - + + - + - - + - + - + 24 3073 + - + - + - - + - + + - + - + - + - 25 8582 - + + - + - + - + - - + - + + - - + 26 14766 + - + - - + - + + - + - - + - + + - 27 18807 + - + - + - - + + - + - - + + - + - 28 19073 - + + - + - + - + - - + - + - + - + 29 19535 + - + - - + - + - + + - - + + - + - 30 23895 + - - + + - - + + - - + - + - + - +Pradhana Vedana: RS - Reduction in sleep time, DS - Difficulty in initiating sleep, WS - Wakefulness during sleepAnubanda vedana: JB – Jrumbha, SG – Shirogaurava, AM – Angamarda, BR – Bhrama, AP – Apakti, SS - ShirashoolaP – Present, A - Absent “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 150
  • Demographic DataGroup – A: Table no 64 Showing Demographical Data Purva Mode of vyadhi Kula vruttanta Occupational History Sl. OPD Onset vruttanta no No. SH Phy Psy Phy S Psy S SS ES C A Sha Mana JF NF Y N Y N Y N 1 8681 + - + + - + - + + - + - + + + - 2 12224 - + - + + - + - - + + - - + - + 3 14194 - + + - - + - + - + - + + - + + 4 14725 - + + - + - - + - + - + - - + - 5 17017 - + - + - + - + - + - + - + - - 6 18197 - + - + - - - + - + - + - - + + 7 18225 - + - + + - - + - + - + - - + + 8 18230 - + - + + - - + + - + - + + - - 9 19051 - + + + - + - + + - + - + + + - 10 19086 - + - + - + + - - + + - - - - - 11 19225 - + - + - + + - - + - + + - - - 12 19495 - + - - + - + - - + + - - + - - 13 19973 - + + + - + - + + - - + + - + + 14 23776 - + - + + - - + - + - + + - - + 15 23775 - + + - + - - + - + - + + - + +Mode of Onset: C – Chronic, A – Acute,Purva vyadhi vruttanta: Sha – Shareerika, Mana – Manasika,Kula vruttanta: JF- Joint Family, NF - Nuclear Family, SH - Staying away from Home, Phy - Physical disturbances in the family, Psy - Psychological disturbances in the family,Occupational History: Phy S - Physical stress, Psy S - Psychological stress, SS - Social stress, ES - Economical stress, Y – Yes, N - No “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 151
  • Demographic DataGroup - B Table no 65 Showing Demographical Data Purva Mode of vyadhi Kula vruttanta Occupational History Sl. OPD Onset vruttanta no No. SH Phy Psy Phy S Psy S SS ES C A Sha Mana JF NF Y N Y N Y N 16 5462 - + - + - + + - + + + - - + - + 17 5467 + - - + + - - + + - + - + + + - 18 5514 + - - + - + - + + - + - + + + - 19 6491 - + + - + - - + - - - + + - - - 20 7406 - + - + + - - + - + + - - + + - 21 2873 - + - + - + + - - + + - - + - - 22 2852 - + + - + - + - + - - + + - - - 23 3120 - + - + + - + - - + + - - + + - 24 3073 - + - + - + - + + - + - + + - + 25 8582 - + - - - + + - - + - + - - + - 26 14766 - + - - - + - + - + - + - - - + 27 18807 - + - + + - - + + - + - + + - + 28 19073 - + + - + - - + + - - + + - - + 29 19535 - + + - + - - + + - - + + - + - 30 23895 - + - + - + - + - + + - - + + +Mode of Onset: C – Chronic, A – Acute,Purva vyadhi vruttanta: Sha – Shareerika, Mana – Manasika,Kula vruttanta: JF- Joint Family, NF - Nuclear Family, SH - Staying away from Home, Phy - Physical disturbances in the family, Psy - Psychological disturbances in the family,Occupational History: Phy S - Physical stress, Psy S - Psychological stress, SS - Social stress, ES - Economical stress, Y – Yes, N - No “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 152
  • Demographic DataGroup –A Table no 66 Showing Demographical DataSl. OPD Ahara Vihara Agni Koshta Vysanano No. V M H M S S M T V Mr M K T C A S TO1 8681 - + - - + + - - - - - + + - - - +2 12224 - + - - - - + - - - - + - + - - -3 14194 + - + - - + - - - - + - - + - - +4 14725 - + - + - - - + - - + - + - + + +5 17017 + - - - + + - - - - - + + - - - +6 18197 - + + - - - + - - - + - - + + + +7 18225 - + - - - - - + - - + - - + + - +8 18230 + - - - + + - - - - - + - + - - -9 19051 + - - - + + - - - - - + + - - - +10 19086 - + - - - - + - - - + + - - - -11 19225 + - - - + - + - - - - + - + - - +12 19495 - + - + - - - + - - + - - + - + +13 19973 + - + - - + - - - - - + + - + - +14 23776 - + - - + + - - - - - + + - + + +15 23775 - + + - - + - - - - - + - + - + +Ahara: V –Vegetarian, M –Mixed.Vihara: H- Hard, M – Moderate, S –Sedentary.Agni: S – Sama, M – Manda, T – Teekshna, V – Vishama.Koshta: Mr – Mridu, M– Madhyama, K– Krura.Vysana: T – Tea, C– Coffee, A–Alcohol, S – Smoking, To – Tobacco “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 153
  • Demographic DataGroup - B Table no 67 Showing Demographical DataSl. OPD Ahara Vihara Agni Koshta Vysanano No. V M H M S S M T V Mr M K T C A S TO16 5462 + - + - - + - - - - + - + - - + +17 5467 - + - - + + - - - - - + - + - - +18 5514 + - - - + + - - - - - + - + - - -19 6491 - + - - - + - - - - + - + - - + +20 7406 + - - - + + - - - - - + + - - - +21 2873 - + - - - - - + - - + - + - + - -22 2852 + - - - - - - + - - + - - + + - -23 3120 + - + - - + - - - - + - - + + - -24 3073 + - + - - + - - - - - + + - - - +25 8582 - + - - - + - - - - + - + - - - -26 14766 - + - - + - - + - - + - - + + - -27 18807 - + + - - + - - - - - + + - - + -28 19073 - + - + - + - - - - + - + - + + +29 19535 - + - - + - - + - - - + + - + + +30 23895 + - + - - + - - - - - + + - + - -Ahara: V –Vegetarian, M –Mixed.Vihara: H- Hard, M – Moderate, S –Sedentary.Agni: S – Sama, M – Manda, T – Teekshna, V – Vishama.Koshta: Mr – Mridu, M– Madhyama, K– Krura.Vysana: T – Tea, C– Coffee, A–Alcohol, S – Smoking, To – Tobacco “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 154
  • Demographic DataGroup – A Table no 68 Showing Demographical Data Sl. OPD Prak Sara Samhan Satmya Satva Ahara Vyama Vaya no No. ruti ana shakti shakti P M A P M A SA E R S V P M A P M A P M A B M V 1 8681 VP - - + - + - - - + - - - + - - + - - + - - + - 2 12224 VP - + - - - + - - - - + - - + - - + - + - - + - 3 14194 VP - + - + - - - - - - + - - + - + - + - - - + - 4 14725 VK - + - - + - - - + - - - + - + - - - + - - + - 5 17017 VP - - + - + - - - + - - - - + - + - - + - - + - 6 18197 VP - + - + - - - - - - + - - + - - + + - - - + - 7 18225 VK + - - - - + - - + - - - + - + - - - + - - + - 8 18230 VP - - + - + - - - - - + - - + - + - - + - - + - 9 19051 VP - - + - + - - - + - - - - + - + - - + - - + - 10 19086 VK + - - - - + - - - - + - - + - - + - + - - + - 11 19225 VP - + - - + - - - + - - - + - - - + - + - - + - 12 19495 VP - + - - + - - - - - + - + - + - - - + - - + - 13 19973 PK - - + - + - - - + - - - + - - + - + - - - + - 14 23776 VP - + - + - - - - - - + - - + - + - - + - - + - 15 23775 PK - - + + - - - - - - + - - + - + - + - - - + -Prakruti: V – Vataja, P – Pitta, K – Kapha, VP – Vatapittaja, VK – Vatakaphaja, PK – Pittakaphaja, S - SamaSara: P – Pravara, M – Madhyama, A – AvaraSamhanana: P – Pravara, M – Madhyama, A – Avara.Satmya: SA – Sarvarasa, E – Ekarasa, R – Ruksha, S - Snigda V – Vyamishra.Satwa: P – Pravara, M – Madhyama, A – Avara.Ahara shakti: P – Pravara, M – Madhyama, A – Avara.Vyamashakti: P – Pravara, M – Madhyama, A – Avara.Vaya: B – Bala, M – Madhyama, V – Vruddha “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 155
  • Demographic DataGroup – B Table no 69 Showing Demographical Data Sl. OPD Prak Sara Samhan Satmya Satva Ahara Vyama Vaya no No. ruti ana shakti shakti P M A P M A SA E R S V P M A P M A P M A B M V 16 5462 VP - + - - + - - - - - + - - + - + - + - - - + - 17 5467 VP - + - - - + - - + - - - - + - + - - + - - + - 18 5514 VP - - + - - + - - + - - - - + + - - - - + - - + 19 6491 VK + - - + - - - - + - - - + - - + - - + - - + - 20 7406 VK - + - - - + - - - - + - - + - + - - - + - + - 21 2873 VP + - - - + - - - + - - - + - - - + - + - - + - 22 2852 VP - + - - + - - - - - + - - + - - + - + - - + - 23 3120 VP + - - - + - - - - - + - - + - + - + - - - + - 24 3073 PK - - + - - + - - + - - - - + - + - - - + - - + 25 8582 VK + - - + - - - - + - - - + - + - - - + - - + - 26 14766 VK - + - - + - - - + - - - - + - - + - - + - + - 27 18807 VP - + - - - + - - + - - - + - - + - + + - - + - 28 19073 PK - + - - - + - - + - - - + - - + - - + - - + - 29 19535 VK - + - - + - - - + - - - - + - - + - + - - + - 30 23895 VP - + - + - - - - - - + - - + - + - + - - - + -Prakruti: V – Vataja, P – Pitta, K – Kapha, VP – Vatapittaja, VK – Vatakaphaja, PK – Pittakaphaja, S - SamaSara: P – Pravara, M – Madhyama, A – AvaraSamhanana: P – Pravara, M – Madhyama, A – Avara.Satmya: SA – Sarvarasa, E – Ekarasa, R – Ruksha, S - Snigda V – Vyamishra.Satwa: P – Pravara, M – Madhyama, A – Avara.Ahara shakti: P – Pravara, M – Madhyama, A – Avara.Vyamashakti: P – Pravara, M – Madhyama, A – Avara.Vaya: B – Bala, M – Madhyama, V – Vruddha “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 156
  • Demographic DataGroup – A Table no 70 Showing Demographical DataSl. OPD Aharaja Hetu Viharaja Hetu Manasika Hetuno No. R L S K A/P D A U/L AS V AV VD B C Kr M Vy 1 8681 + + - - - - - + + - - + + - + - + 2 12224 - + - + + + - - - + - + - + - + - 3 14194 - - + - - + + - + - + - - + - + + 4 14725 + + - + - + - - + - - - + - + - + 5 17017 + + - - + - - - - + - + - + + + - 6 18197 - + - - + + + - - + + - - + - + + 7 18225 + + + + - - - - - + - - + - - - + 8 18230 - - + - - + - + + - - + + + - + + 9 19051 + + - - - - - - + - - + + + + + - 10 19086 - + + - - + - - - + - - + - - + 11 19225 + - - - - - - - + + - + - - - + + 12 19495 - + - - + + - - - - - - - - - - - 13 19973 + + + - - - + - - + + + + - + - + 14 23776 - - - - + - - - - - - + - + - + - 15 23775 - + - - + + + - + - + + - + + + +Aharaja Hetu: R – Rukshanna, L – Laghu, S – Sheeta, K – Katu, A/P - Alpa/ PramithaViharaja Hetu: D – Divaswapnam, A - Ati-Vyayama, U/L - Upavasa/ Langanam, AS – Asukhashayya, V – Vishamaupachara, AV - Ati-vyavaya, VD – VegadharanaManasika Hetu: B – Bhaya, C – Chinta, Kr – Krodha, M – Manasthapa, Vy – Vyatha “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 157
  • Demographic DataGroup – B Table no 71 Showing Demographical DataSl. OPD Aharaja Hetu Viharaja Hetu Manasika Hetuno No. R L S K A/P D A U/L AS V AV VD B C Kr M Vy 16 5462 - + - + - + + - - - + - - + - + + 17 5467 + - - - + - - + + + - + + + + + + 18 5514 + + - - + + - + + + - + + + + + + 19 6491 + - + + - + - - + - - - - - + - + 20 7406 - + - - + - - + - + - + + + - + - 21 2873 + - + - - + - - - + - - - - + - + 22 2852 - + + + - + - - + - - - - + - - - 23 3120 - + + + - + + - + + + - + - + - - 24 3073 + + - - + + + + - + + + + + - + + 25 8582 + - + + - - - - + - - - - - + - - 26 14766 + - - + + + - + + + - - + + - - + 27 18807 + - - - + - + + - - + + - - + + - 28 19073 + - + + - - - - + + - - - - - + - 29 19535 + - - + - + - - + + - + + + + + + 30 23895 - + + + - - + - + - + + + + - - +Aharaja Hetu: R – Rukshanna, L – Laghu, S – Sheeta, K – Katu, A/P - Alpa/ PramithaViharaja Hetu: D – Divaswapnam, A - Ati-Vyayama, U/L - Upavasa/ Langanam, AS – Asukhashayya, V – Vishamaupachara, AV - Ati-vyavaya, VD – VegadharanaManasika Hetu: B – Bhaya, C – Chinta, Kr – Krodha, M – Manasthapa, Vy – Vyatha “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 158
  • Subjective Parameter Group – A (Sarpi Nasya) Table no 72 Showing Subjective Parameter Statistical Data of Group ANumber of AM SG JB SL DIS SQ PDA VMA Patients BT AF BT AF BT AF BT AF BT AF BT AF BT AF BT AF 01 1 1 1 0 1 0 3 2 3 1 2 1 3 1 3 1 02 0 0 1 0 1 0 2 1 2 0 2 0 2 0 2 0 03 1 0 1 1 0 0 3 2 3 1 3 1 3 1 3 1 04 0 0 1 1 0 0 3 1 3 1 3 1 3 2 3 1 05 1 0 1 0 1 0 2 2 3 2 3 1 2 1 2 1 06 1 1 1 0 0 0 3 1 2 1 2 1 3 1 3 2 07 0 0 1 0 1 0 2 0 2 0 3 0 2 0 2 0 08 1 0 1 1 0 0 3 2 3 1 3 1 3 1 3 2 09 1 1 1 1 0 0 4 2 3 1 3 2 3 1 3 1 10 1 0 0 0 1 0 2 0 1 0 2 0 2 0 2 0 11 1 0 1 1 0 0 3 2 3 1 2 1 3 2 3 1 12 0 0 1 0 1 0 2 1 2 1 2 1 3 1 2 1 13 1 1 1 1 0 0 4 2 3 1 3 2 3 1 3 1 14 1 0 0 0 1 0 2 1 2 0 3 1 2 1 2 1 15 1 1 1 1 0 0 4 2 3 2 3 2 3 1 3 2AM – Angamarda, SG – Shirogaurava, JB – Jrumbha, SL – Sleeplessness, DIS - Difficulty in Initiating Sleep,SQ - Sleep Quality, PDA - Performance of Daily Activities, VMA - Vitality after Morning Awakening.BT – Before treatment, AF – After Follow-up “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 159
  • Subjective Parameter Group – B (Yastiksheera Dhara) Table no 73 Showing Subjective Parameter Statistical Data of Group BNumber of AM SG JB SL DIS SQ PDA VMA Patients BT AF BT AF BT AF BT AF BT AF BT AF BT AF BT AF 01 1 0 1 0 0 0 4 1 3 0 3 0 3 0 3 0 02 1 0 1 0 0 0 4 0 3 0 3 0 3 0 3 0 03 1 0 1 0 1 0 4 1 3 1 3 1 3 2 3 1 04 0 0 1 0 1 0 2 0 2 0 2 0 3 0 2 0 05 1 0 0 0 0 0 3 1 3 0 3 0 2 0 3 0 06 0 0 1 0 1 0 2 0 2 0 3 0 2 0 2 0 07 0 0 1 0 1 0 3 1 3 0 3 0 3 0 3 0 08 1 0 1 0 0 0 2 0 2 0 3 0 3 0 2 0 09 1 1 0 0 0 0 4 1 3 0 3 1 2 0 2 1 10 0 0 1 0 1 0 2 0 2 0 3 0 2 0 2 0 11 1 0 1 0 0 0 2 0 2 0 2 0 3 0 3 0 12 1 1 1 0 0 0 4 1 3 0 3 1 3 1 3 1 13 0 0 1 0 1 0 2 0 2 0 3 0 2 0 3 0 14 1 0 0 0 0 0 3 1 2 0 3 0 3 0 2 0 15 0 0 1 0 0 0 4 1 3 0 2 0 3 0 2 0AM – Angamarda, SG – Shirogaurava, JB – Jrumbha, SL – Sleeplessness, DIS - Difficulty in Initiating Sleep,SQ - Sleep Quality, PDA - Performance of Daily Activities, VMA - Vitality after Morning Awakening.,BT – Before treatment, AF – After Follow-up “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 160
  • Objective Parameter Group – A (Sarpi Nasya) Table no 74 Showing Objective parameter Statistical Data of Group – A Number of Total Sleep Time Wakefulness During Sleep Patients BT AF BT AF 01 3 1 3 1 02 2 0 1 0 03 3 1 3 1 04 3 1 3 1 05 2 2 3 1 06 3 1 2 1 07 2 0 2 0 08 3 2 3 1 09 4 2 2 2 10 1 0 1 0 11 3 2 3 1 12 2 1 2 1 13 4 2 3 2 14 2 1 1 1 15 4 3 2 2 BT – Before treatment, AF – After Follow-up“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 161
  • Objective Parameter Group – B (Yastiksheera Dhara) Table no 75 Showing Objective parameter Statistical Data of Group – B Number of Total Sleep Time Wakefulness During Sleep Patients BT AF BT AF 01 4 0 3 0 02 4 0 2 0 03 4 1 3 1 04 2 0 2 0 05 3 0 2 0 06 2 0 2 0 07 3 0 1 0 08 2 0 1 0 09 4 1 3 1 10 2 0 1 0 11 2 0 2 0 12 4 1 3 1 13 2 0 3 0 14 3 0 2 0 15 4 0 3 0 BT – Before treatment, AF – After Follow-up“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 162
  • Sleep Questions Group – A (Sarpi Nasya) Table no 76 Showing Sleep Questioners Statistical Data of Group A Number of Questioner Patients BT AF 01 3 2 02 2 0 03 3 2 04 3 2 05 2 1 06 3 3 07 2 0 08 3 2 09 3 3 10 2 0 11 3 2 12 3 3 13 3 3 14 2 1 15 3 3 BT – Before treatment, AF – After Follow-up“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 163
  • Sleep Questions Group – B (Yastiksheera Dhara) Table no 77 Showing Sleep Questioners Statistical Data of Group B Number of Questioner Patients BT AF 01 3 0 02 3 0 03 3 2 04 3 0 05 2 0 06 2 0 07 3 0 08 2 0 09 2 2 10 2 0 11 3 0 12 3 2 13 2 0 14 3 0 15 2 0 BT – Before treatment, AF – After Follow-up“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 164
  • Discussion DISCUSSIONDiscussions on this study are made under the following headings: 1. Discussion on the disease Nidranasha vis-à-vis Insomnia. 2. Discussions on the materials and methods. 3. Discussion on clinical study. 4. Discussions on the patients of Nidranasha who underwent the trial. 5. Discussions on observations made on results. 6. Probable mode of action of the Nasya and Ksheera dhara.1. Discussion on the disease Nidranasha vis-à-vis Insomnia Nidra – an essential phenomenon for maintenance and restoration of the life,which is considered under Trayopastambha. Charaka included the Asvapna in 80Nanatmaja Vata Vikaras. Acharya Sushruta explained this under the chapter GarbhaVyakarana Shariram, might be because of Nidra plays a role of nutrition anddevelopment of the body. He also explained the Vaikariki Nidra in the same chapter,which can be correlated to sleep disorders. Nidranasha can be correlated to Insomnia.Insomnia is defined as repeated difficulty with the initiation, duration, maintenance,or quality of sleep that occurs despite adequate time and opportunity for sleep thatresults in some form of daytimeThe treatments which are described for Anidras according to various classics can beclassified as♦ Bahya upachara♦ Ahara upachara♦ Manasika upachara♦ Anya upachara“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 165
  • Discussion Charaka mentioned Abhyanga, Utsadana, Samvahana, Akshitarpana, ShiroLepa, Karna Purana, Shiro Basti, Shirodhara, Moordhni Taila as bahya upacharas.Manonukula vishaya grahana,Manonukula sabda granaha,Manonukula gandhagranaha as manasika upacharas and Gramya mamsa rasa,Anupa mamsa rasa,Jaleeyamamsa rasa,Mahisha ksheera,Peeyusha,Morata as manasika upacharas. Despite therecent progress in the use of non-benzodiazepines, physicians remain reluctant toprescribe drugs with sedative properties, i.e. hypnotics, because the risks areperceived to be too high. Many physicians have the impression that onerous side-effect are inevitable. In general, physicians should favor short-acting hypnotics overlong-acting drugs in primary insomnia when short-term use is anticipated. Chronicinsomnia associated with the anxiety disorders respond better to hypnotics with longerhalf-lives to reduce daytime anxiety.2. Discussions on the materials and methods.A. Drugs used in the trial work:Mahisha sarpi: According to Vagbhata Mahisha Ghrita is having the property of Nidrajanakaand also best Rasayana effect. Also Mahisha ksheera indicated in Nidranasha byKaiyyadeva nigandu / Gritha varga / 273 It improves Smriti, Medha, Buddhi, Varna,Swara, Saukumaryata and Ojas in the body; it strengthens sensory organs and softensthe body. Ghrita is recommended as main pathya in Vatavyadhis. In Vata disordersSneha instantaneously provides nourishment to Ksheena Dhatus, it promotes Bala,Agni and longevity of life. The Sarpi was used for the Nasya karma after murchana. The Mahisha sarpimurchana is done according to the Ghrita murchana procedure explained inBhaishajya Ratnavali, Jwara prakarana.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 166
  • DiscussionMurchita Tila Taila: The Murchita Tila Taila is used for the sthanika abhyanga in urdwajatrugatapradesha, as explained in clasics that Nasya should be administered after Snehana andSwedana. Murchitha tila taila is also used for shiro abhyanga prior to Shirodhara. ThisSthanika Abhyanga may help in absorption of medicaments used for dhara, asexplained in Pharmocology that hydrated skin is more permeable than dry skin.Yastimadhu sidda Mahisha Ksheera: Acharya Vagbhata directly indicated the mahisha kseera in Nidranasha. AlsoMahisha ksheera indicated in Nidranasha by (Haritha Samhitha 8/21). Yastimadhuhaving the properties like Madhura rasa, Guru-snigda-sheeta guna, sheeta veerya,Madhura vipaka, Vata pitta shamaka. So this drug may precipitate the Nidra. As thereis involvement of psychological factor in Anidra, Shirodhara is a choice of treatment.For this Shirodhara, yastimadhu is processed in Mahisha ksheera according toKsheerapaka vidhi is used.B. Posology:Sarpi Nasya- 8 drops of Sarpi nasya is administered to each nostril for 7 days. 8drops was fixed on the basis of dose of Nasya explained by acharya Charaka. This isthe Madhyama matra of Marsha nasya. Duration of treatment was fixed for 7 days onthe basis of Acharya Vagbhatas opinion.Yasti ksheera Dhara – Dhara was performed for 7 days as explained in Ayurvedictreatment by Dr. Moss. Dhara karma is done in Arohana karma for first 4 days andAvarohana from 5th to 7th day i.e. 30 min on first day, daily increased 5 min till 4thday(45min) then decreased 5 min each day so that on 7th day it was again 30 min.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 167
  • Discussion3. Discussion on Clinical Study: The Patients were selected from OPD and IPD of D.G.M. Ayurvedic MedicalCollege & Hospital, Gadag after applying the Inclusion & Exclusion criteria. Thenthey are randomly distributed into two groups- Group A and Group B and treatmentwas administered. Totally 32 patients got registered out of which 2 discontinued thetrial because of their personal problems. After scrutinizing the Ayurvedic literature and literatures of contemporaryscience, Angamarda, Jrumbha, Shirogaurava, Sleeplessness, Difficulty in initiationsleep, Sleep Quality, Performance of daily activities, Vitality after morningawakening, Total Sleep Time (hrs) and Wakefulness during sleep (in number), SleepHistory Questionnaire were fixed as the parameters for clinical assessment. In Group A - Nasya was administered in evening hours in between 4pm to6pm after stanika abhyanga with Murchitha taila and swedana with Mrudu nadisweda. The Nasya was administered in the evening hours as there is involvement ofVatadosha in the Samprapthi of Nidranasha, and it is explained in the classics that inVataroga Nasya should be administered in “Aparahna”. (A.H.Su.19/37). Nasya wasadministered in lying supine position over Massage table with a pillow below theneck region, so that there is slight elevation of head which helps in administration ofNasya dravya. After Nasya pranidhana, patient was asked to take slow deep breaththrough nose and exhale through mouth. The pani and pada is rubbed vigorously forshort time. Slight massage was done over urdwajatrugata pradesha after nasyapranidhana. A comfortable massage on the above regions may help to subside theirritation of the somatic constriction due to heat stimulation and may also help inremoving the slush created in these regions. Manipulation over carotid sinus of neck“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 168
  • Discussionpresent on the bifurcation of common carotid artery which has the receptors calledbaroreceptors may have a buffering action on cerebral arterial pressure. (Best andTaylor, 1988). Pressure applied on the baroreceptors is also found to normalize thederanged cerebral arterial pressure.(Hejmadi S. 1985) Then patient was asked to lie over massage table for another 10 minutes. Themedicament from mouth was asked to spit in kidney tray. After 10 minutes asked todo gargling with luke warm salt water and then Dhumapana was administered toremove the shesha kapha dosha from srotasas.In Group B, Yasti ksheera dhara was carried out in evening hours 4 pm-6 pm aftershiro abhyanga with murchita tila taila, as there is predominance of Vata dosha duringthese hours (A.H.Su.1). Patient was asked to lie down in Dhara table after shiro abhyanga. Then thickgauze was tied around the head above the eye brow to avoid flow of medicine in toeyes. The eyes are also covered with a piece of cotton to avoid any splash ofmedicines into eyes. During the Dhara process, absolute calm surrounding wasmaintained. After Dhara, head of patient was cleaned with a dried cloth and asked totake rest for half hour. Afterward asked to take luke warm water head bath. Rasnadichurna was rubbed to head after proper drying the head with dry towel.Assesment results: The efficacy of Sarpi nasya and Yasti ksheera dhara in nidra nasha wasaccessed by setting of criteria as discussed in materials and methods section earlier.Here the base line data was compared with the data taken after 14 days of therapy;this is because the parihara kala for Panchakarma procedure is told as double the daysof administration of karma. Hence it is postulated that the result of Nasya and Dharacan be best seen after parihara kala. In this study the course of therapy was 7 days and“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 169
  • Discussionhence the results were accessed 14 days after the therapy i.e. on 22nd day of the firstday of treatment initiation.4. Discussions on the patients of Nidranasha who underwent the trial: Age: Out of 30 patients of Nidranasha studied in this series, maximum i.e.60.00% of patients were in the age group of 20 – 35 yrs followed by 33.33% patientsin the age group of 36 - 50 yrs. In the age of 20 – 35yrs, chinta may be prime factorwhich in turn influences the vata to aggravate resulting in nidranasha. Sex: The number of male patients 66.66% was more in this series incomparison to female 33.33%. The prevalence made by earlier researchers that thisdisease is more in women than men. Though the females might suffer more from theNidranasha complaint, here they did not turn up for the treatment. Religion: Religion wise distribution showed maximum patients 83.33% wereHindus, whereas only 10.00% patients were christian and. whereas only 6.66%patients were muslims. Here hindus are more in geographical proportions. Occupation: where 36.66% were sedentary, whereas 30.00% were labor,23.33% of patients in this study were belonging to students and whereas 10.00% wereexecutives. In this study the more peoples are belonged to sedentary group may bedue to their business. Economical Status: The present series of study showed maximum number is36.66% were middle class, whereas 33.33% of patients were belongs to poor class and30.00% were higher class. Marital status: In this study 63.33% patients were married and whereas36.66% patients were unmarried. Here maximum number of patient belongs tomarried group, because of chinta and manasthapa.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 170
  • Discussion Addiction: An investigation to the addiction of patients showed the maximumnumber of patients were addicted to Tea 56.66%, Coffee 43.33%, followed by40.00% to alcohol, 33.33% to Alcohol and whereas 63.33% patients were havingtobacco addiction. It has been reported that caffeine, nicotine, alcohol all can alter sleep patterns.Though they provide sleep initially but fall in blood concentration leads increasedarousal due to sympathetic stimulation. Koshta: In the present study maximum number of patients 46.66% belongedto madyama and 53.33% belongs to Krura koshta which highlights the predisposingfactors for vata. Satva: In this series maximum number of patients were avara satva 63.33%and 36.66% were belongs to the madyama satva. Avara Satva persons have unsteadymind for which they have no control over Krodha, Chinta, etc. which leads toNidranasha condition.Vyayama shakti: Majority of patients in this series were of madyama vyayama shaktiis 63.33%, whereas 26.66% were pravara group and avara vyayama shakti 13.33%.Hetus: Aharaja hetu: In this study 56.66% patients were taken the Rukshanna,60.00% patients were taken the Laghu ahara, 40.00% patients were taken the Sheetaahara,40.00% patients were taken the katu ahara and 40.00% patients were taken theAlpa/Pramitha. Viharaja Hetu: In this study 56.66% were of Divaswapnam, 30.00% werehad Ati-Vyayama, 26.66% were Upavasa/ Langanam, 56.66% were Asukhashayya,53.33% were Vishamaupachara, 09 (30.00%) were Ati-vyavaya and 16 (53.33%)were Vegadharana.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 171
  • Discussion Manasika Hetu 46.66% were of Bhaya, 60.00% were had Chinta, 46.66%were Krodha, 56.66% were Manasthapa and 63.33% were Vyatha. All these are saidto be the direct cause for Nidranasha as they provokes Raja, Vata, Pitta and decreasesSatva, Tama and Kapha. These causative factors independently or in conjugationcause Nidranasha. Present complaint: The patients in this study showed Out of thirty patients66.66% were belonging to Reduction in sleep time, 73.33% were of Difficulty ininitiating sleep, 80.00% were of Wakefulness during sleep. Associated symptoms: Associated symptoms complained by the patients36.66% were had Jrumbha, 83.33% were had Shirogaurava, 66.66% were hadAngamarda, 36.66%, were had Bhrama, 50.00%, were had Apakti and 60.00% werehad Shirashoola.Comparison of effect of both therapies:Sarpi Nasya – Sarpi Nasya shown better relief in complaints Jrumba andSleeplessness.Yastiksheera dhara: Provided better relief in Angamarda, Shirogaurava, Difficultyin initiating Sleep, Sleep Quality, Performance of Daily Activity, Vitality afterMorning Awakening, Total Sleep Time, Wakefulness during Sleep It shows that Sarpi Nasya done with Sarpi as well as Yastiksheera dharaprovided significant relief in all the signs and symptoms, improved the quality andquantity of sleep in the patients of Nidranasha. However comparison showed that theeffects of Yastiksheera dhara were better in comparison to be Sarpi nasya.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 172
  • Discussion5. Discussions on observations made on results: Assessment of the results was done by considering the subjective parametersand objective. Totally 8 criteria were taken with different grading as explained. Thestatistical result showing the significance has already been discussed in theobservation part. For this purpose the values were observed numerically which are given the –Now the % of the condition after the treatment is calculated by dividing this numberwith the base line data obtained by the step 1. This should then multiply by 100 to getthe % after the treatment.Step 1 – All the values of before treatment of subjective and objective parameterswere added to get the sum. Now this is the condition in which the patient hadapproached us, so it becomes the base line data. This is taken as 100%.Step 2 – The readings of after treatment was then added to get the sum, which is thestatus of the patient after the treatment.Step 3 – Now the % of the condition after the treatment is calculated by dividing thisnumber with the base line data obtained by the step 1. This should then multiply by100 to get the % after the treatment.Step 4 – The % of improvement is calculated by subtracting the value got by step 3by 100 will yield the net improvement in the disease.Step 5 – This value was referred for the table postulated to declare the results and thetable is gradings.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 173
  • DiscussionTable Showing the Percentage Improvement of Parameters in each patient.Group A – Sarpi Nasya Group B – Yastiksheera DharaSI No OPD No % improvement SI No OPD No % improvement 1 8681 60.8% 16 5462 96.0% 2 12224 66.6% 17 5467 100.0% 3 14194 62.5% 18 5514 69.0% 4 14725 59.0% 19 6491 100.0% 5 17017 50.0% 20 7406 95.0% 6 18197 55.0% 21 2873 100.0% 7 18225 100.0% 22 2852 95.0% 8 18230 52.0% 23 3120 100.0% 9 19051 46.0% 24 3073 72.0% 10 19086 100.0% 25 8582 100.0% 11 19225 50.0% 26 14766 100.0% 12 19495 58.0% 27 18807 72.0% 13 19973 48.0% 28 19073 100.0% 14 23776 62.5% 29 19535 94.7% 15 23775 33.0% 30 23895 95.4%Overall Assessment of Clinical Response: Good Response : >75% improvement in clinical parameters Moderate Response : 50-75% improvement in clinical parameters Poor Response : up to 50% improvement in clinical parameters No Response : 0 % or No improvement in clinical parametersGroup AResponse No of Patients Group A no. and %Good Response 02 13.33%Moderate Response 10 66.66%Poor Response 03 20.00%No Response 00 00 In this group, the chief complaint and Associated complaint was reduced upto 50% in most of the patients on 5th or 6th day. The other complaint, likesleeplessness not shown any changes during the period of treatment, the recurrencesof the complaints were not observed during the period of follow up.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 174
  • DiscussionGroup BResponse No of Patients Group B no. and %Good Response 12 80.00%Moderate Response 03 20.00%Poor Response 00 00No Response 00 00 In this group, all the chief complaint and associated complaint was reduced upto 80% in most of the patients on 5th or 6th day. The recurrences of the complaintswere not observed during the period of follow up. There was no much difference in response was noted during the treatmentperiod in both group. But much difference in response was noted after the follow upperiod in both groups. Only the Parameter Jrumbha not had shown much difference inpatients even after follow up.Mean Percentage improvement in each Parameter: The mean percentage of improvement in each parameter was calculated toknow the effect of treatment on individual parameters. These was calculated by usingthe following formula (Before Treatment Mean)–(After treatment Mean)X100Mean % Improvement = (Before Treatment Mean)“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 175
  • DiscussionTable Showing the obtained values are as followsSI No Parameter Group A Group B Overall 01 Angamarda 54.5% 77.7% 66.1% 02 Shirogaurava 46.0% 100.0% 73.0% 03 Jrumbha 100.0% 100.0% 100.0% 04 Sleeplessness 50.0% 82.2% 66.1% 05 Difficulty in Initiating Sleep 65.7% 97.3% 81.5% 06 Sleep Quality 61.5% 92.8% 77.15% 07 Performance of Daily Activities 65.0% 92.5% 78.5% 08 Vitality After Morning Awakening 61.5% 92.1% 76.8% 09 Total Sleep time 53.6% 93.3% 73.4% 10 Wakefulness during Sleep 55.8% 90.6% 73.2% 11 Sleep History Question 32.5 85.0 58.75% Among all parameter the Difficulty in Initiating Sleep had shown the highestpercentage (65.7%) improvement in Group A (Sarpi Nasya) and in Group B(Yastiksheera Dhara) the Shirogaurava (100.0%), Difficulty in Initiating Sleep(97.3%) had shown highest percentage (73.4 %) of improvement. The ParameterJrumbha had shown the 100% improvement in both groups.Overall response of patients: In Group – A: Out of fifteen patients, 02 (13.33%) shown Good response(>75% improvement in clinical parameters) to the treatment. 10 (66.66%) were shownModerate response (50-75% improvement in clinical parameters), 03 (20.00%)patients shown Poor response(up to 50% improvement in clinical parameters) andnone were shown No response.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 176
  • DiscussionGroup B: Out of fifteen patients 12 (80.00%) were shown Good response (>75%improvement in clinical parameters) to the treatment. 03 (20.00%) were shownModerate response (50-75% improvement in clinical parameters), none patientsshown Poor response (up to 50% improvement in clinical parameters), none wereshown No response. In total thirty patients, only 14 (46.66%) patient shown Good response (>75%improvement in clinical parameters) to the treatment. 13 (43.33%) were shownModerate response (50-75% improvement in clinical parameters), 03 (10.00%)patients shown Poor response (up to 50% improvement in clinical parameters) andnone were shown No response.To know compare the effectiveness of the treatment procedure, the statistical analysisis done by using Un-paired t-test, by assuming that the mean effect treatmentprocedures is same in both the groups after treatment procedure. From the analysisexcept the Angamarda all other parameters shows more significant (as P<0.05). i.e.,the mean effects treatment procedure is not same as in all other parameters. But inJrumba parameter there is no significance difference after the treatment. To know on which parameters the treatment procedure is more effective, thestatistical analysis is done by using paired t-test, by assuming that the treatmentprocedure is same in both groups in all the parameters. From the analysis all parameters shows highly significant as P<0.05. From theanalysis in Group B the parameter Angamarda, Shirogaurava, Difficulty in InitiatingSleep, Sleep Quality, Vitality after Morning Awakening, Total Sleep Time,Wakefulness During Sleep and Sleep Quality shows more highly significant thanGroup A. In Group A the parameter Jrumba and Sleeplessness shows more highly“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 177
  • Discussionsignificant than Group B. But the parameter Performance of Daily Activities showsequal effect in Group A and Group B.Statistical Conclusion: Over all the Group B(Yastiksheera Dhara) is better than GroupA (Sarpi Nasya) in most parameters. The parameter Jrumba is not significant meansthis parameter is not necessary for this study. Further study can be conducted byconsidering sample by Age, Sex, and Profession and by extending duration of thetreatment.6. Probable mode of action of the Nasya and Ksheera dhara:Probable Mode of action of Nasya Karma: The Mahisha Sarpi was used for Nasya karma in this study. The cleardescription regarding the mode of action of the Nasya Karma is not available inAyurvedic classics. According to Charaka, Nasa is the gate way of Shirah (Cha. Si.2/22). The drug administered through nose as Nasya reaches to the brain and iminatesonly the morbid Doshas responsible for producing the disease. The sarpi administered through the Nasa may reach up to the ShringatakaMarma present inside the Nasa srotas and from there it may spread all over the Shirasas it is the meeting place of siras related to Nasa, Shrota, Akshi, Kanta. The head in lowering position may help in the retention of medicine inNasopharynx, which may help in providing sufficient time for local drug absorptionand lipid soluble substance has great chance for passive absorption through the cell oflining membrane. In this present study, Mahisha sarpi was used and as it was a lipidsubstance, may get absorbed through cell membranes of Nasal lining. Theenhancement in absorption may expect by Pre and Post facial massage and sudationas it is explained that it increases the local blood circulation. The efferent vasodilatornerves, which are spread out on the superficial surface of face, receive stimulation by“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 178
  • Discussionfomentation and may increase the blood flow to the brain i.e. momentary hyperemia.So, it can be stated that the modus operandi of nasya karmas has a definite impact oncentral neurovascular system and likely to lower the blood brain barrier, which makespossible the absorption of Mahisha sarpi in the brain tissue.Probable Mode of Action of Shirodhara: The mode of action of Yasti Ksheera Shirodhara may be understood in thefollowing lines:♦ Effect through Relaxation♦ Effect through the drugs used for ShirodharaEffect through Relaxation: Forehead is the area where Sthapani Marma is situated. Stimulation throughShirodhara to Marma may exert action over pituitary gland which is the master glandof endocrine system. Apart from this Ajna Chakra is also situated in the forehead.When the medicine poured from particular height the relaxation of frontalis muscletends to normalize the body mechanism. This results in decrease in the activity ofsympathetic nervous system with lowering heart rate, respiration, blood pressure,muscle tension, brain cortisone and adrenalin level. Shirodhara makes the patient to concentrate over this area by which patientmay get stability of mental functions and provides relaxation. It is well evident thatthe Shirodhara provides relaxation to the persons subjected to it. When the medicine is poured from a particular height certain amount ofpressure is exerted over the area. Also some amount of Kinetic energy may beproduced. This may stimulate the nerves, tactile and thermo receptors.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 179
  • DiscussionEffects of the drugs used for the Shirodhara Bhrajaka Pitta situated in Avabhasini (Stratum Conium) layer of skin utilizesand enables the digestion of medicines used for the Shirodhara. Thus the veerya of themedicine absorbed by stratum conium goes through the hair follicles and spreads allover the body through Tiryak gami Dhamani. This will result in the SampraptiVighatana of the disease. Certain amount of drug absorption is possible by the topical applications whenthey are in lipid media. There are few possible routes for absorption. Route ofpenetration is through the follicular pores to the follicles and then to dermis viasebaceous glands. The permeability of sebaceous gland is greater than that of granularlayer of epidermis. In Yasti siddha Ksheera Dhara, the medicine is suspended in the lipid media,which enhances the drug absorption. When it poured to the forehead there will bemaximum absorption of the drug. In this way the veerya of the Yastimadhu alongwith Ksheera, which are used for the Shirodhara may absorbed and enter in the bloodand may do the Samprapti vighatana. The results obtained in Nasya therapy group were maintained with slightimprovement in the values during treatment. But in the Yastiksheera dhara groupthere was high improvement seen during follow-up period, remained just as before thestart of the treatment. Hence, Yastiksheera dhara was better than Nasya in providingoverall improvement in Nidranasha.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 180
  • Conclusion CONCLUSION • Sarpi Nasya and Yasti ksheera Dhara can be practiced safely without any adverse effect. • Overall the group B is more effective clinically and statistically than group A in almost all the parameters. • Sarpi Nasya can be done on large samples, so that definite conclusions can be drawn as the present study is limited to small sample of 30 patients.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 181
  • Summary SUMMARY The thesis entitled “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” comprises following parts.1. Introduction2. Objectives of the study3. Review of literature4. Methodology5. Observation and results6. Discussion7. ConclusionIntroduction: In this part includes importance of Sarpi Nasya and Yastiksheera dhara in Nidranasha and about the disease entity Nidranasha and its prevalance and regarding Insomnia.Objectives of the study: (1) To evaluate the efficacy of Nasya karma in Nidranasha. (2) To evaluate the efficacy of Yastiksheera Dhara in Nidranasha. (3)To compare the efficacy of Yastiksheera Dhara versus Sarpi Nasya inNidranasha It includes need for the study, objectives of the study, previous research workson Nidranasha, conclusions of previous works on Nidranasha and reasons behindselection of specific therapy for this disease with Sarpi Nasya and Yastiksheera dhara.Review of literature: This part includes mainly historical review of Sarpi Nasya, Yastiksheera dharaand Nidranasha. Description regarding nirukti and paribhasha of Nasya andDharakarma, various Nasya bhedas, yogya-ayogya, procedure to perform Nasya and“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 182
  • SummaryDhara along with Pariharakala. Review of Nidranasha includes disease etymology,nirukti, classifications, nidana, purvaroopa, rupa, samprapti, upashaya-anupashaya,pathya-apathya etc. Description regarding the Insomnia, its disorder and differenttreatments. In the drug review description concerning about properties and preparation ofMurchita ghrita, Yastimadhu ksheera paka and Murchita tila taila.Study Design: The study design set for the present study is ‘A Comparative ClinicalStudy’.Sample size and Grouping: The sample size for the present study was 30 patientssuffering from Nidranasha as per the selection criteria and was randomly distributedto both the groups of equal size. In Group A, 15 patients received Sarpi Nasya and inGroup B, 15 patients received Yastiksheera Dhara.Inclusion criteria: Patients suffering from classical signs and symptoms ascomplaining of reduction in sleep time, Difficulty in Initiating Sleep, Wakefulnessduring Normal Sleep, Any of the above (or) all of the above will be included.Exclusion criteria: Nidranasha due to other conditions like Madatyaya, Nidranashadue to Abhigata, Pregnant Woman, Lactating Mothers, Associated with any othersystemic and metabolic disorder, Severe Psychic disorder and with Kaphaja Vikaraswere excluded.Study duration: In Group A, Sarpi Nasya was administered for 7 days and follow upperiod was 14 days. Total study duration was 21 days. In Group B, Yastiksheera Dhara was administered for 7 days and follow upperiod was 14 days. Total study duration was 21 days.Posology:“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 183
  • Summary Nasyakarma: 8 drops in each nostril as Marsha Nasya – madhyamamatra.was done Dharakarma: Total 1 to 11/2 litres of Yasti ksheera was done.Methods of Assessment of Clinical Response: Subjective parameters and objectiveparameters were made out to assess the Clinical response.Subjective Parameters: Anganmarda, Shirogaurava, Jrumbha, Sleeplessness,Difficulty in Initiating Sleep, Sleep Quality, Performance of Daily Activities, VitalityAfter Morning Awakening,Objective parameters: Total Sleep time, Wakefulness during Sleep, Sleep HistoryQuestionResult: All these parameters of baseline data to post-medication data (22nd day) werecompared for clinical assessment of the results.In this study, in Group A two patient (13.33%) shown Good response (> 75%improvement in subjective and objective parameters) where 10 patients (66.66 %)were shown Moderate response (50-75% improvement in subjective and objectiveparameters) and 03 (20.00 %) were shown Poor response (<50% improvement insubjective and objective parameters).In Group B, 12 patients (80.00 %) were shown Good response (> 75% improvementin subjective and objective parameters) and 03 patients (20.00 %) were shownModerate response (50-75% improvement in subjective and objective parameters). Among all parameter the Difficulty in Initiating Sleep had shown the highestpercentage (65.7%) improvement in group A and in Group B the Shirogaurava(100.0%), Difficulty in Initiating Sleep (97.3%) had shown highest percentage (73.4%) of improvement. The Parameter Jrumbha had shown the 100% improvement inboth groups.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 184
  • SummaryStatistical Analysis: To know compare the effectiveness of the treatment procedure, the statisticalanalysis is done by using Un-paired t-test, by assuming that the mean effect treatmentprocedures is same in both the groups after treatment procedure. From the analysisexcept the Angamarda all other parameters shows more significant (as P<0.05). i.e.,the mean effects treatment procedure is not same as in all other parameters. But inJrumbha parameter there is no significance difference after the treatment. To know on which parameters the treatment procedure is more effective, thestatistical analysis is done by using paired t-test, by assuming that the treatmentprocedure is same in both groups in all the parameters. From the analysis allparameters shows highly significant as P<0.05. From the analysis in Group B theparameter Angamarda, Shirogaurava, Difficulty in initiating Sleep, Sleep Quality,Performance of Daily Activity, Vitality after Morning Awakening, Total Sleep Time,Wakefulness during Sleep and Sleep Question shows more highly significant thanGroup A. In Group A the parameter Jrumbha and Sleeplessness shows more highlysignificant than Group B. But the parameter PDA shows equal effect in Group A andGroup B.Conclusion: Over all the Group B is better than group A in most parameters. Theparameter Jrumbha is not significant means this parameter is not necessary for thisstudy. Further study can be conducted by considering sample by Age, Sex, andProfession and by extending duration of the treatment.Methodology:“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 185
  • Summary This possesses about the selection criteria, study design, plan of the study,posology, subjective and objective parameters and grading for assessment criteria’s.Observation and result: It includes observation on all demographic data’s with their percentage andgraphical representation about the same, regarding the observation nidanas,purvaroopas, lakshanas and results of individual symptoms followed overall responseof the treatment.Discussion: Nidranasha vis-à-vis Insomnia, Discussions on the materials and methods,Discussion on clinical study, Discussions on the patients of Nidranasha, whoundergone the trial, Mode of Action of Sarpi Nasya and Yastiksheera Dhara,Discussion on Sarpi Nasya and Yastiksheera Dhara.Conclusion: This is the last part of the present study. This section comprises of theConclusion on the whole study.“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha A Comparative Clinical study” 186
  • Bibliography BIBLIOGRAPHY1. (a) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.1, Ninth edition, and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.287. (b) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th,shloka no.3, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office,Varanasi, Page.no.223.2. (a) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th,shloka no.7, First edition, and print 2006, Pub: Chowkhamba Sanskrit Series Office,Varanasi, Page.no.223. (b) Dr.S.Suresh Babu edited Research Methodology for Ayurvedic scholars, 2ndedition, Pub: Chaukhamba Orientalia, Varanasi.3. www.medscapegeneralmedicine.com4. Alexander Z.Golbin, Howard M.Kravitz, Louis G.Keith Edited,Sleep Psychiatry, Firstedition and imprint 2005, Pub: Taylor & Francis Group, USA.5. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter 9th,shloka no.88, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.722.6. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan Ram Acharyaedited Susruta Samhita, Chikitsasthana, Chapter 40th, Reprint 2003, Pub: ChaukhambaSurbharati Prakashan, Varanasi, Page no.552.7. Prof.K.R.Srikanta Murthy edited Sharangadhara Samhita, Uttara kandha, Chapter 8th,Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no. 222.8. Prof P.V.Tewari edited Kasyapa Samhita, Siddhisthana, Chapter 4th, Reprint 2002,Pub: Chaukhambha Visvabharati, Varanasi, Page no 287.9. Sri Brahmasankara Misra and Sri Rupalalaji Vaisya edited Bhavaprakasha (Nighantu),Prathama bhaga, Chapter 7th, Eleventh edition 2004, Pub: Chaukhambha SanskritSansthan, Varanasi, Page no.775.10. Siddharth N.Shah edited API Text book of Medicine, 7th edition 2003, Pub: TheAssociation of Physician of India, Page No. 79511. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shlokano.18, First edition, and print 2006, Pub: Chowkhamba Sanskrit Series Office, Varanasi,Page.no.203. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 187
  • Bibliography12. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 31st, shlokano.10, First edition, and print 2006, Pub: Chowkhamba Sanskrit Series Office, Varanasi,Page.no.232.13. Vaidya Vishnu Mahadev Gogte produced Ayurvedic Pharmacology & Therapeuticuses of Medicinal plants, Octomber 2000, Pub: Bharatiya vidya Bhavan, Mumbai,Page.no.457.14. (a) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 6th,shloka no.28, First edition, and print 2006, Pub: Chowkhamba Sanskrit Series Office,Varanasi, Page.no.39. (b) Sri Brahmasankara Misra and Sri Rupalalaji Vaisya edited Bhavaprakasha(Nighantu), Prathama bhaga, Chapter 11th, Eleventh edition 2004, Pub: ChaukhambhaSanskrit Sansthan, Varanasi, Page no.768.15. Dr.Polepally Yadaiah edited Clinical Panchakrma, Chapter 2nd, Second edition 2008,Pub: Jaya Publications, Akola (M.S), Page.no.15.16. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shlokano.2, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi,Page.no.223.17. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.21, Reprint2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.554.18. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 1st,shloka no.85, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.21.19. Sri Brahmasankara Misra and Sri Rupalalaji Vaisya edited Bhavaprakasha, Prathamabhaga, Chapter 5th, Sloka no.322, Eleventh edition 2004, Pub: Chaukhambha SanskritSansthan, Varanasi, Page no.151.20. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter9th, shloka no.89 - 92, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi,Page no.722.21. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.22, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.555.22. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.28, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.555. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 188
  • Bibliography23. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.7, Ninth edition, and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.288.24. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.44, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556.25. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter9th, shloka no.107, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.723. (b) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.44, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556.26. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter5th, shloka no.46, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.41. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.7, Ninth edition, and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.288.27. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 5th,shloka no.49, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.41.28. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 5th,shloka no.20 - 26, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.39.29. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 21th, shloka no.9, Ninth edition, and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.296.30. (a) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.53, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.557. (b) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana,Chapter 9th, shloka no.116 - 117, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan,Varanasi, Page no.723.31. (a) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.26, Ninth edition, and reprint 2005, Pub:Chaukhamba Orientalia, Varanasi, Page.no.292. (b) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th,shloka no.20, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office,Varanasi, Page.no.226. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 189
  • Bibliography32. (a) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.26 - 28, Ninth edition, and reprint 2005, Pub:Chaukhamba Orientalia, Varanasi, Page.no.292. (b) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th,shloka no.21 - 22, First edition, and print 2006, Pub: Chowkhambha Sanskrit SeriesOffice, Varanasi, Page.no.226.33. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.24, Ninth edition, and reprint 2005, Pub:Chaukhamba Orientalia, Varanasi, Page.no.292.34. (a) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.27 - 28, Ninth edition, and reprint 2005, Pub:Chaukhamba Orientalia, Varanasi, Page.no.292. (b) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.51, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.557. (c) Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Uttara kandha, Chapter8th, Sloka.no.41 – 42, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no.222.35. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter9th, shloka no.92, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.722. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.2, Ninth edition, and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.287.36. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter9th, shloka no.96 - 97, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi,Page no.723.37. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shlokano.5, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi,Page.no.223.38. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Siddhiasthana, Chapter 9th, Sloka no.93, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.72239. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.23, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.555. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 190
  • Bibliography40. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana (Indu), Chapter 29th,shloka no.5, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office,Varanasi, Page.no.223.41. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shlokano.6, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi,Page.no.223.42. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Vimanasthana,Chapter 8th, shloka no.139, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan,Varanasi, Page no.284. (b) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter th9 , shloka no.97, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.723.43. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.22, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.555.44. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter9th, shloka no.94, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.722.45. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter9th, shloka no.95, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.723.46. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shlokano.8, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi,Page.no.223.47. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Vimanasthana, Chapter8th, shloka no.151, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.286.48. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.21, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.554.49. (a) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.2, Ninth edition, and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.287. (b) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th,shloka no.4, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office,Varanasi, Page.no.223. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 191
  • Bibliography50. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.7, Ninth edition and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.288.51. (a) Prof P.V.Tewari edited Kasyapa Samhita, Siddhisthana, Chapter 2nd, Sloka.no.17– 19, Reprint 2002, Pub: Chaukhambha Visvabharati, Varanasi, Page no 269. (b) Prof P.V.Tewari edited Kasyapa Samhita, Siddhisthana, Chapter 4th, Sloka no.3Reprint 2002, Pub: Chaukhambha Visvabharati, Varanasi, Page no 287.52. Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Uttara kandha, Chapter 8th,Sloka.no.2, 11 & 24, fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no.222, 224 & 225.53. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita (Dalhana), Chikitsasthana, Chapter 40th, Sloka no.44 -45, Reprint 2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556.54. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shlokano.22, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi,Page.no.227.55. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter2nd, shloka no.23, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.690.56. (a) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.24, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.555. (b) Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Uttara kandha, Chapter8th, Sloka.no.3, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no.222.57. (a) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana (Indu), Chapter29th, shloka no.16, First edition, and print 2006, Pub: Chowkhambha Sanskrit SeriesOffice, Varanasi, Page.no.225.58. (a) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.36, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana (Arunadhatta), chapter 20th, shloka no.16, Ninth edition and reprint 2005,Pub: Chaukhamba Orientalia, Varanasi, Page.no.290. (c) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th,shloka no.18, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office,Varanasi, Page.no.226. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 192
  • Bibliography59. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter9th, shloka no.93, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.722.60. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter2nd, Sloka no.22, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.690.61. (a) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.54 - 55, Reprint2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.557. (b) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter nd2 , shloka no.20, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.689. (c) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.11 - 13, Ninth edition and reprint 2005, Pub:Chaukhamba Orientalia, Varanasi, Page.no.289.62. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter9th, shloka no.98, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.723. (b) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.25 - 55, Reprint2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.555. (c) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th,shloka no.15, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office,Varanasi, Page.no.225. (d) Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Uttara kandha, Chapter th8 , Sloka.no.47, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no. 228.63. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.25, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.555.64. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter9th, shloka no.101 - 102, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi,Page no.723. (b) Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Uttara kandha, Chapter8th, Sloka.no.47 - 53, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no.228.65. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter9th, shloka no.102, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.723. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 193
  • Bibliography66. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter9th, shloka no.108 - 110, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi,Page no.723. (b) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.32 - 35, Reprint2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556. (c) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.22, Ninth edition and reprint 2005, Pub:Chaukhamba Orientalia, Varanasi, Page.no.291. (d) Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Uttara kandha, Chapter th8 , Sloka.no.47 - 53, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no.228.67. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.31, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556.68. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter9th, shloka no.106, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.723.69. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.30, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556.70. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter9th, shloka no.104, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.723.71. (a) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.20 - 24, Ninth edition and reprint 2005, Pub:Chaukhamba Orientalia, Varanasi, Page.no.291.72. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 30th, shlokano.2, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi,Page.no.227.73. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 30th, shlokano.7, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi,Page.no.228.74. (a) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.18, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.554. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 194
  • Bibliography (b) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana (Indu), Chapter th30 , shloka no.17, First edition, and print 2006, Pub: Chowkhambha Sanskrit SeriesOffice, Varanasi, Page.no.230.75. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 20th, shloka no.22, Ninth edition and reprint 2005, Pub:Chaukhamba Orientalia, Varanasi, Page.no.291.76. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.32 - 36, Reprint2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556.77. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.56 - 57, Reprint2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.557.78. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sharirasasthana, Chapter 6th, Sloka no.18 - 20, Reprint2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.372.79. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Siddhisthana, Chapter2nd, shloka no.22, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.690.80. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sharirasasthana, Chapter 6th, Sloka no.28, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.372.81. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shlokano.3, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi,Page.no.223.82. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 40th, Sloka no.40, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.556.83. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shlokano.2 - 3, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office,Varanasi, Page.no.223.84. Ross & Willson (1981): Foundation of Anatomy and Physiology, 5th edition, Pub:ELBS, London.85. Ashtavaidyan Vayaskara N.S.Mooss produced Ayurvedic Treatments of Kerala,Chapter 5th, Second edition 1946, Pub: Vaidya Sarathy, Kottayam, Page.no.35. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 195
  • Bibliography86. P.S.Varier produced Chikitsa Samgraham, Sixth edition 2004, Pub: Arya Vaidya sala,Kottakal, Page.no.137.87. Dr.Polepally Yadaiah edited Clinical Panchakrma, Chapter 2nd, Second edition 2008,Pub: Jaya Publications, Akola (M.S), Page.no.15.88. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter22nd, Sloka no.11, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.120.89. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 22nd, Sloka no.23, Ninth edition and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.301.90. Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Uttara kandha, Chapter 11th,Sloka.no.122, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no. 249.91. Keraleeya chikitsa samgraham by P.K.Krishna Varier and S.Subrahmanian,Vasudevavilasam publications, Trivandrum.92. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sharirasasthana, Chapter 9th, Sloka no.9, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.385.93. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sharirasasthana, Chapter 6th, Sloka no.25, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.373.94. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter 21st,Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page no.118.95. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sutrasthana, Chapter 24th, Reprint 2003, Pub:Chaukhamba Surbharati Prakashan, Varanasi, Page no.113.96. Prof P.V.tewari edited Kasyapa Samhita, Sutrasthana, Chapter 25th, Sloka.no.40 – 49,Reprint 2002, Pub: Chaukhambha Visvabharati, Varanasi, Page.no.57.97. Prof. Priya Vrat Sharma edited Bhela Samhita, Chikitsasthana, Chapter 23rd, Reprint2005, Pub: Chaukhambha Visvabharati, Varanasi, Page.no.445.98. Ramavalamba Shastri edited Harita Samhita, Chikitsasthana, Chapter 15th, Firstedition 1985, Pub: Prachya Prakashan, Varanasi, Page.no.297. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 196
  • Bibliography99. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter11th, Sloka.no.35, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.74.100. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter8th, Sloka.no.3 - 4, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.55.101. (a) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th,shloka no.27, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office,Varanasi, Page.no.91. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 7th, shloka no.52, Ninth edition and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.140.102. (a) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sutrasthana, Chapter 24th, Sloka.no.7 Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.114. (b) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sharirasthana, Chapter 24th, Sloka.no.32 Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.358.103. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter21st, Sloka.no.36, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.118.104. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter21st, Sloka.no.59, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.119.105. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sharirasthana, Chapter 4th, Sloka.no.33 Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.358.106. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter21st, Sloka.no.51, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.119107. Prof P.V.Tewari edited Kasyapa Samhita, Kilasthana, Chapter 5th, Sloka.no.7,Reprint 2002, Pub: Chaukhambha Visvabharati, Varanasi, Page no 484.108. Sri Brahmasankara Misra and Sri Rupalalaji Vaisya edited Bhavaprakasha,Prathama bhaga, Chapter 3rd, Sloka no.317, Eleventh edition 2004, Pub: ChaukhambhaSanskrit Sansthan, Varanasi, Page no.60. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 197
  • Bibliography109. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter21st, Sloka.no.35, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.118.110. Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Purvakandha, Chapter 6th,Sloka.no.24 - 25, fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no. 30.111. Ramavalamba Shastri edited Harita Samhita, Chikitsasthana, Chapter 1st,Sloka.no.53, First edition 1985, Pub: Prachya Prakashan, Varanasi, Page.no.453.112. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sharirasthana, Chapter 4th, Sloka.no.31 or 34, Reprint2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.352.113. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shlokano.49, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi,Page.no.94.114. Prof P.V.Tewari edited Kasyapa Samhita, Sutrasthana, Chapter 28th, Sloka.no.32,Reprint 2002, Pub: Chaukhambha Visvabharati, Varanasi, Page.no.86.115. Ramavalamba Shastri edited Harita Samhita, Sharirasthana, Chapter 1st,Sloka.no.54, First edition 1985, Pub: Prachya Prakashan, Varanasi, Page.no.453.116. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sharirasthana, Chapter 4th, Sloka.no.33, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.358.117. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sharirasthana, Chapter 4th, Sloka.no.56, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.360.118. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 8th, Sloka no.28, Ninth edition and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.153.119. Prof. Priya Vrat Sharma edited Bhela Samhita, Chikitsasthana, Chapter 21st,Sloka.no.1 – 6, Reprint 2005, Pub: Chaukhambha Visvabharati, Varanasi, Page.no.431.120. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shlokano.7, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi,Page.no.87.121. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter21st, Sloka.no.58, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.119. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 198
  • Bibliography122. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shlokano.49, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi,Page.no.94.123. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter11th, Sloka.no.35, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.74.124. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter21st, Sloka.no.36 - 38, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi,Page no.118.125. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter20th, Sloka.no.11, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.113.126. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sharirasthana, Chapter 4th, Sloka.no.33, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.358.127. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shlokano.27, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi,Page.no.91.128. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 7th, Sloka no.52, Ninth edition and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.140.129. Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Purvakandha, Chapter 7th,Sloka.no.112, 119 & 122, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Pageno.40, 41 & 41.130. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter25th, Sloka.no.40, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.132. (b) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Uttarasthana, Chapter 55th, Sloka.no.16, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.777. (c) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th,shloka no.53 - 56, First edition, and print 2006, Pub: Chowkhambha Sanskrit SeriesOffice, Varanasi, Page.no.94. (d) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 4th, Sloka no.12, Ninth edition and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.55. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 199
  • Bibliography (e) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 7th, Sloka no.62 - 63, Ninth edition, and reprint 2005, Pub:Chaukhamba Orientalia, Varanasi, Page.no.143. (f) Ramavalamba Shastri edited Harita Samhita, Threetiyasthana, Chapter 15th,Sloka.no.4, First edition 1985, Pub: Prachya Prakashan, Varanasi, Page.no.298.131. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter11th, Sloka.no.45, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.76.132. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Nidanasthana, chapter 2nd, Sloka no.42, Ninth edition, and reprint 2005, Pub:Chaukhamba Orientalia, Varanasi, Page.no.454.133. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter21st, Sloka.no.55 - 57, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi,Page no.119.134. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sharirasthana, Chapter 4th, Sloka.no.42, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.359.135. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Nidanasthana, chapter 7th, Sloka no.62 - 63, Ninth edition and reprint 2005, Pub:Chaukhamba Orientalia, Varanasi, Page.no.143.136. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shlokano.41 - 42, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office,Varanasi, Page.no.93.137. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Chikitsasthana, Chapter28th, Sloka.no.19, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.617.138. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter7th, Sloka.no.23, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.50.139. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Uttarasthana, Chapter 55th, Sloka.no.16, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.779.140. (a) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 9th, Sloka no.50 - 53, Ninth edition and reprint 2005, Pub:Chaukhamba Orientalia, Varanasi, Page.no.95. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 200
  • Bibliography (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited Astanga Hrudaya,Sutrasthana, chapter 7th, Sloka no.64, Ninth edition and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.143.141. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sharirasthana, Chapter4th, Sloka.no.34, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.323.142. Prof.K.R.Srikanta Murthy edited Sarangadhara Samhita, Purvakandha, Chapter 7th,Sloka.no.32, Fourth edition, Print 2001, Pub: Chaukhambha Orientalia, Page no.34.143. Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Chikitsasthana, Chapter 24th, Sloka.no.88, Reprint 2003,Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.491.144. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 9th, shlokano.44 - 46, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office,Varanasi, Page.no.93.145. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter21st, Sloka.no.52 -54, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi,Page no.119.146. Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter25st, Sloka.no.45, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.132.147. A.C.Guyton text book of Medical Physiology, 8th edition 1991, Pub: W.B.SaundersCompany - USA (Prism Books Pvt, Ltd, Bangalore, India), Page.no.659.148. C.C.Chatterji – Human Physiology, 11th edition, Indian Allied Medical Agency, Vol– I, Page.no.265149. Alexander Z.Golbin, Howard M.Kravitz and Louis G.Keith edited Sleep Psychiatry,First edition and imprint 2005, Pub: Taylor & Francis Group, USA.150. Oxford Dictionary, Produced in Great Brtian in 1998, reprinted in 2007, Pub:dorling Kindersely Limited and Oxford University Press, London, Page.no.780.151. www.wrongdiagnosis/insomnia.com.152. (a) Kaplon and Sadock’s Synopsis of Psychiatry, Chapter 24th, Eighth edition 1998,Pub: B.I.Waverly Pvt.Ltd, New Delhi, Page.no.737. (b) R.S.Satoskar edited Pharmacology and Pharmacotherapeutics, Chapter 6th,Sixteenth edition 1999, Pub: Popular Prakashan Private Limited, Mumbai, Page.no.100. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 201
  • Bibliography153. (a) Vaidya Jadavji Trikamji Acharya edited, Charaka Samhitha, Sutrasthana, chapter27th, Sloka.no.286-288, Reprint 2004, Pub: Choukambha Sanskri, Sansthana, Varnasi,Page.no.169-170. (b) Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheerthaedited, Susruta Samhitha, Sutrasthana, Chapter 45th, Sloka no.112, Reprint 2004, Pub:Choukambha Krishnadas academy Varanasi, Page.no.205. (c) Dr. G.S. Pandey edited Shri. Bhavamishra, Bhavaprakasha Nighantu,Tailavarga, Shloka.no.2-7, 6th Edition, Pub: Chaukhambha Bharati Academy,1982.Varanasi, Page.no.779.154. Dr.Ramachan Dra Reddy M.D edited Bhaishajya Kalpana Vijnanam, Chapter.5, 1stEdition, Pub: Chaukhambha Sanskrit Bhawana,1998, Varanasi, Page.no.371.155. (a) Ramavalamba Shastri edited Harita Samhita, Threetiyasthana, Chapter 8th,Sloka.no.75, First edition 1985, Pub: Prachya Prakashan, Varanasi, Page.no.62. (b) Prof.Priyavrata Sharma and Dr.Guru Prasada Sharma edited Kaiyyadeva nigantu,Grita varga, Sloka.no.273, first edition 1979,Pub: Chaukhambha Orientalia, Varanasi,Page.no.369. (c) Dr.Indradev Tripathi and Dr. Daya Shankar Tripathi produced Yogaratnakara,Gritha varga, Sloka.no.1, Pub: Krishnadas Academy, Varanasi, Page.no.83.156. (a) Prof P.V.Sharma edited Dravya guna Vijnana vol – 2, Pub: ChaukhambhaBharati Academy, Varanasi, Page.no.253. (b) Dr.K.M.Nadkani’s edited Indian Materia Medica, reprint – 1996, Pub: PopularPrakasha Private Limited, Page.no.582.157. (a) Vaidya Jadavji Trikamji Acharya edited Charaka Samhitha, Sutrasthana, Chapter27th, Sloka.no.219, Reprint 2004, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Pageno.165. (b) Vaidya Jadavji Trikamji Acharya & Narayan Ram Acharya and Narayan RamAcharya edited Susruta Samhita, Sutrasthana, Chapter 45th, Sloka.no.55 - 56, Reprint2003, Pub: Chaukhamba Surbharati Prakashan, Varanasi, Page no.201. (c) Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 6th,shloka no.28, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office,Varanasi, Page.no.39. (d) Pt. Bhisagacharya Harishasthri Paradkara Vaidya edited Astanga Hrudaya,Sutrasthana, chapter 5th, Sloka no.23, Ninth edition and reprint 2005, Pub: ChaukhambaOrientalia, Varanasi, Page.no.69. (e) Ramavalamba Shastri edited Harita Samhita, Threetiyasthana, Chapter 8th,Sloka.no.21, First edition 1985, Pub: Prachya Prakashan, Varanasi, Page.no.24.158. Bhisagratna Shri Brahmashankar Mishra edited Bhaisajyaratnavali, Chapter 5th,Sloka.no.1287, Eighteen Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan,Varanasi, Page no.185. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 202
  • Bibliography159. Bhisagratna Shri Brahmashankar Mishra edited Bhaisajyaratnavali, Chapter 5th,Sloka.no.1285, Eighteen Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan,Varanasi, Page no.185.160. Dr.Shivaprasad Sharma edited Astanga Samgraha, Sutrasthana, Chapter 29th, shlokano.18, First edition, and print 2006, Pub: Chowkhambha Sanskrit Series Office, Varanasi,Page.no.226.161. Prof.K.S.Srikantha Murthy translated Sarangadara samhitha, Madyama khanda,Chapter 2nd, Sloka 161, first edition (1984), Pub: Chaukhambha Orientalia, Varanasi,Page no- 75.162. P.S.Varier produced Chikitsa Samgraham, Sixth edition 2004, Pub: Arya Vaidyasala, Kottakal, Page.no.137.163. Kaplon and Sadock’s Synopsis of Psychiatry, Chapter 24th, Eighth edition 1998,Pub: B.I.Waverly Pvt.Ltd, New Delhi, Page.no.737. “The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 203
  • Special case sheet SPECIAL CASE SHEET FOR NIDRANAHSA Post Graduate studies and research centre, (Panchakarma) Shri. D.G.M Ayurvedic Medical College, GadagGuide: Dr.Suresh Babu M.D (Ayu) Scholar: Dr.G.Deepak.Co-Guide: Dr Santhosh.N.Belavadi. M.D (Ayu)1. Name of the patient _________________________ SL. No O.P.D. No2. Father’s / Husband’s Name ___________________ I.P.D. No3. Age ______ yrs, Place of Birth _______________4. Sex M F Education __________________5. Marital Status Married ( ) Unmarried ( )6. Religion Hindu. ( ) / Muslim ( ) / Christian ( ) Others ( )7. Occupation Labour ( ) Student ( ) Executive ( ) Sedentary ( )8. Economical status Poor ( ) / Lower Middle ( ) / Upper Middle ( ) / Rich ( )9. Address ________________________ E-mail ID _________________ _________________________ Phone No: ______________ D M Y D M Y10. Date of schedule initiation Completion11. Treatment: Group A Group B Sarpi Nasya Yastiksheera Dhara Good Moderate Poor No12. Result Response Response Response ResponseCONSENT I am fully educated with the disease and treatment there by I got satisfied. Iaccept for medical trail on me happily. Signature of Patient“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 204
  • Special case sheetPradhana Vedana with DurationSI No Pradhana Vedana P A Avadhi 1 Reduction in sleep time 2 Difficulty in initiating sleep 3 Wakefulness during sleepAnubanda vedanaSI No Anubandhi vedhana Present Absent 1 Jrumbha 2 Shirogaurava 3 Angamarda 4 Jadya 5 Glani 6 Bhrama 7 Apakti 8 Shira shoolaVyadhi vruttantaMode of onset Chronic Acute Yes NoRoutine activities affected:Purva vyadhi vruttanta Factors Yes No DetailsShareerikaManasika“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 205
  • Special case sheetChikitsa vruttanta:S.No History Yes No Details01 Allopathic treatment02 Ayurvedic treatment03 Other modalitiesKula vruttanta: Joint Family Nuclear Family .Staying away from Home Yes NoPhysical disturbances in the Yes NofamilyPsychological disturbances in the Yes NofamilyOccupational History: Yes NoPhysical stressPsychological stressSocial stressEconomical stressAny habit before Sleep (going to bed):“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 206
  • Special case sheetVayaktika vruttanta :1 Ahara Vegetarian ( ) Mixed ( )2 Vihara Nature of work : Hard ( ) Moderate ( ) Sedentary ( )3 Agni Samāgni ( ) Mandagni ( ) Teekshāgni ( ) vishamāgni ( )4 Kostha Mrudu ( ) Madhyama ( ) Krura ( )5 Vyasana None ( ) Tobacco ( ) Smoking ( ) Alcohol ( )6 Artava Regular ( ) Irregular ( ) Menopause ( )Samanya PareekshaVital examination01 /min Heart Rate02 Resp. rate /min03 Blood Pressure mm of Hg04 Body Temp /F05 Body weight Kgs.Ashta sthana Pareeksha:01 Nadi /min02 Mala03 Mootra04 Jihwa05 Shabda06 Sparsha07 Druk08 Akruti“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 207
  • Special case sheetC. Dasha vidha Pareekshā01 Prakruti V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) Sama ( )02 SĀRA Pravara. ( ) Madhyama. ( ) Avara ( )03 Samhanana Pravara ( ) Madhyama. ( ) Avara ( )04 Pramana Pravara ( ) Madhyama. ( ) Avara ( )05 Sātmya Ekarasa. ( ) Sarva rasa ( ) Vyamishra ( ) Rooksha satmya ( ) Snigda satmya ( )06 Satva Pravara ( ) Madhyama ( ) Avara ( )07 Ahara Shakti a) Abhyavaharana shakti P ( ) M ( ) A ( ) b) Jarana shakti P( )M( )A( )08 Vyayam Shakti Pravara ( ) Madhyama ( ) Avara ( )09 Vaya Bala ( ) Yuva ( ) Vrudda ( )Nidana: Aharaja Hetu Viharaja Hetu Manasika Hetu AnyaRukshanna Divaswapnam Bhaya VamanaLaghu Ati-Vyayama Chinta VirechanaSheeta Upavasa/ Krodha Shirovirechana LanganamKatu Asukhashayya Manasthapa RakthamokshanaAlpa/ Vishamaupachara Vyatha Dhatu kshayaPramitha Ati-vyavaya Abhigata VegadharanaLaboratory Examination (if any)“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 208
  • Special case sheetChikitsa for Group A Sarpi Nasya – 8 drops in each nostril for 7 days Date of Initiation - Date of Completion - Days Time of Procedure Observation 1 2 3 4 5 6 7Chikitsa for Group B Yastiksheera dhara : -1200ml (approx) for 7 days Date of Initiation - Date of Completion - Time of Days Administration Duration Observation Starting Completion 1 2 3 4 5 6 7“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 209
  • Special case sheetAssessment of Criteria’sSubjective Parameters Anubandha vedana Before Treatment After Follow-upAngamardaShirogauravaJrumbhaSleeplessness BT AFNo complaintDisturbed Sleep during nightGets sleep after taking sedativesDoesn’t get sleep at allDifficulty in initiating sleep BT AFSleep immediately after go to bedOne hour late sleep after go to bedTwo hours late sleep after go to bedMore than Two hours late after go to bedSleep Quality BT AFEnjoyable sleepAnxious or agitated before and during sleepFeeling unfreshed and unrest after sleepSleep experience negative and not enjoyable“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 210
  • Special case sheetPerformance of daily activities BT AFNo DisturbanceSlightly DisturbedModerately DisturbedHighly DisturbedVitality after morning awakening BT AFFeeling FreshnessSleepy or fatiguedPoor concentrationIrritating mindObjective ParametersTotal Sleep Time (hrs) BT AFNormal sleep (8hrs)Adequate sleep (8-6hrs)Inadequate sleep (6-4hrs)Sleep less than 4hrsNo sleep at nightWakefulness during sleep (In number) BT AFNo wakefulnessOne to two times wakefulness3 to 4 times wakefulnessMore than 4 times wakefulness“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 211
  • Special case sheetSleep History QuestionnaireS.No. Questions BT AF 1 Do you nap during the day? 2 Do you have trouble concentrating during the day? 3 Do you trouble falling asleep when you first go to bed? 4 Do you awaken during the night? 5 Do you awaken more than once? 6 Do you awaken too early in the morning? 7 Are you regularly awakened at night by pain or the need to use the bathroom? 8 Does your job require shift changes? 9 Do you drink caffeinated beverages (coffee, tea, or soft drinks)? 10 Have you ever suffered from depression, anxiety or similar problem? Guide- signature Co-guide signature Investigator’s signature [G.Deepak]“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 212
  • Special case sheetTotal Assessment of Results:Subjective Parameters: Parameters Before After Follow- Treatment upAngamardaJrumbhaShirogauravaSleeplessnessDifficulty in initiation sleepSleep QualityPerformance of daily activitiesVitality after morning awakeningObjective Parameters: Parameters Before After Follow- Treatment upTotal Sleep Time (hrs)Wakefulness during sleep (in number)“The Effect of Sarpi Nasya and Yastiksheera Dhara in Nidranasha – A Comparative Clinical study” 213